Maternal health
Maternal mortality is particularly high in South countries with 95% of the 570 000 deaths recorded annually during pregnancy. Women in South countries are a hundred times more likely to die during childbirth than women in developed countries. Most deaths are due to haemorrhages. Complications are not always fatal but can leave serious aftereffects which result in social exclusion and poverty.
Abortions often take place in catastrophic conditions, especially when this right is not recognized by law. At least 80 000 women, often young women (70% in Africa are under 20), die every year because of this.
Suitable policies can make all the difference. Results can be very different between comparable countries: in the 1990s Vietnam, Lesotho and Nepal had mortality ratios ranging from one to ten whereas their GNP per capita were quite similar (between US$1 000 and US$1 200). The best results stem from coherent strategies in terms of quality, availability and accessibility (geographical, economic, sociocultural) of healthcare delivery during pregnancy and delivery. Fertility control is also an important factor in reducing maternal mortality.
There is a pressing need to help Least Developed Countries (LDCs) combat maternal mortality. France has recently defined this as a strategic axis and intends to scale up its multilateral and bilateral contributions. AFD implements the bilateral component of this strategy and systematically analyses reproductive health needs in the countries where it operates. AFD financing, after a country-based analysis and in coordination with other partners, strengthens reproductive health components identified as the most vulnerable.
Strengthening maternal healthcare delivery
Interventions aim at strengthening quality healthcare during pregnancy and particularly delivery. Improving delivery conditions brings down both maternal mortality and morbidity and prevents obstetric fistula due to non-medical deliveries. With an increasing number of women affected by HIV/AIDS, interventions also target HIV testing, mother-to-child transmission prevention and care for HIV positive mothers in maternal healthcare centers. Interventions therefore target:
- prenatal care: promoting contraception and nutrition, preventive care (vaccines, micronutrients, chemoprophylaxis, HIV testing, sexually transmitted infection treatment, mother-to-child transmission prevention) and risk factor screening;
- assistance from a qualified healthcare professional during delivery (doctor, midwife or specialized nurse);
- rapid care for emergencies and complications in adapted and equipped hospital structures open 24/7.
In addition, projects aim to encourage birth control and spacing through the free availability of modern contraceptive methods. The desired impact is threefold: to enhance women’s rights, particularly in terms of sexuality, to reduce maternal mortality and morbidity and demographic control. These strategies are developed in Sahelian African countries in particular where fertility rates remain extremely high (for instance, sometimes over 6 children per mother in Niger, Mali, Burkina Faso and Chad).
To meet these goals AFD financed projects are tailored to specific needs and can support: (i) initial and continuous training for health workers involved in maternal health; (ii) upgrading for basic maternity wards and reference operating theatres (first level); (iii) management, supervision and evaluation of maternal healthcare services and implementation of a reference system and (iv) family planning services within maternal healthcare services.
Efforts to strengthen healthcare systems contribute to reducing maternal mortality and morbidity which are often determined by the smooth functioning of the whole healthcare system. Such sector support can also place a greater focus on the priorities of Ministries of Health, for instance in Niger where strengthening reproductive healthcare services was at the center of the sectoral approach.
Promoting maternal healthcare service demand
As well as strengtheningpreventive and curative healthcare delivery services, strategies also target the healthcare “demand” component by improving, with the available resources, financial, social and cultural accessibility to reproductive healthcare services. Such action in favour of demand is essential in most LDCs where many obstacles prevent women’s access to preventive care or assisted deliveries when they exist. Whenever possible these actions involve women’s group representatives and civil society in general.
Interventions financed by AFD therefore aim to improve financial accessibility to services by supporting a review of maternal healthcare tariffs (or even free treatment) and promoting risk mutualization methods related to childbirth. France has recognized expertise in this field.
An in-depth analysis on cultural, religious or social obstacles is to be carried out in the framework of operational research that AFD proposes to conduct, with specialized research institutes, on demographic transition in Sahelian countries. A specific focus is to study countries which withstand this transition. (Burkina Faso, Mali, Niger etc). This research should make it possible to identify the most effective operational strategies for the promotion of women’s rights to health, healthcare services and effective contraception methods.