November 30, 2016

Maternal Health Supplies: Why Do Women Die Needlessly in Pregnancy and Childbirth in a World Where Prevention Is Entirely Possible?


Beyond gender inequality and disparities in health coverage, postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E) are the two leading causes of maternal deaths. Contributing to the nearly 280,000 deaths each year, these occur overwhelmingly in developing countries. Making essential maternal health medicines available to every woman giving birth would save 1.4 million women’s lives in the next ten years. The policy and financial support for this promise were part of the Millennium Development Goals (MDGs) in 2000 and were strengthened in the recently approved Sustainable Development Goals (SDGs). What we know, however, is that to achieve universal coverage of maternal health services, we cannot rely on traditional, inadequate solutions.

Ten years ago, family planning services that were critical in reducing the number of maternal deaths under the MDGs faced the same constraints. But financing mechanisms, supply chains, and distribution networks are stronger, and the Reproductive Health Supplies Coalition (RHSC) stepped up to partner with countries, procurers, and suppliers to ensure that contraceptive supplies are widely available, even in the poorest countries. The UN Commission on Life Saving Commodities for Women and Children (UNCoLSC) completed its analysis of how low-cost oxytocin and misoprostol can ensure the prevention and treatment of PPH, and how magnesium sulphate can prevent and treat seizures caused by PE/E. Initial efforts to increase coverage will end in June 2016 when the Commission’s mandate ends.

The RHSC is now ready to mobilize its capacity for leveraging more than 350 member organizations to support innovative funding mechanisms, employ sophisticated analytical tools for market development, and embrace effective partnerships to address the bottlenecks that undermine commodity security across the RH space, including maternal health supplies.

To ensure that maternal health commodities and related supplies (i.e., inexpensive blood pressure machines, test sticks for urine) make it into maternal, neonatal, and child health country implementation plans, the RHSC calls on health and financial leaders at the county level to promote the following efforts:

  • Safeguard a supportive policy environment and adequate financial investments in essential maternal health medicines;
  • Strengthen information and supply chains to ensure medicines’ availability, and avoid stock-outs at all health-system levels;
  • Ensure quality control of medicines, until they are delivered to women in need; and
  • Improve health providers’ knowledge and skills so they can appropriately deliver the medicines to the women who need them.

In the 75 countries where more than 95 percent of maternal deaths occur (including the large countries, where maternal mortality is highest—Ethiopia, India, and Nigeria), delivering a package of maternal health services and essential medicines will cost less than US$1.50 per person. But achieving this demands that national governments make strong investments, support prequalified suppliers of maternal health medicines, and ensure that pregnant women attend prenatal care during pregnancy and thereafter to guarantee effective continuum of care, which includes family planning for subsequent birth spacing.

Ultimately, in addition to establishing functioning supply chains for essential maternal health commodities and supplies, changes must be made to health-system coverage, quality of care, and the gender dimensions that limit women’s access to care. We have successful country models (documented in policy briefs from the RHSC) and high-profile advocacy efforts, such as Women Deliver and the Partnership for Maternal, Neonatal, and Child Health. What we lack is the will and commitment to make the ultimate difference. The costs of maternal deaths and disability to families, communities, and economies are too enormous to ignore as we move forward on the SDGs.

John Townsend, PhD, is a vice president and director of the Population Council's Reproductive Health program. He provides leadership, directs research initiatives, and advances policy innovations that translate into better-functioning health systems, improved sexual and reproductive health, and enhanced respect for the right to health for women and men worldwide.

Townsend oversees research focused on three core areas: basic biomedical studies and the development of male and female contraceptives; social science research to identify causes of poor sexual and reproductive health outcomes; and research on the development, scale-up, financing, and sustainability of service-delivery models. He works closely with international health and development agencies, ministries of health, and private healthcare providers to implement policies and programs that encourage more effective healthcare practices; participates in multiple interagency committees on contraceptive technology, gender, and reproductive health services; and represents the Council in meetings with national and international policymakers worldwide.