This article is written by Edward Siddons.
Every day, some 830 women die of pregnancy-related causes or in childbirth, 99% of them in the global south.
Haemorrhages, high blood pressure and infection account for around 75% of those deaths. But a web of social issues also determines risk, including poverty, age, ethnicity and geography.
Progress has been made: the global maternal mortality rate fell by around 44% between 1990 and 2015. That’s still far short of UN targets, however, and progress has not benefited all women equally.
Better policy could save thousands of lives every year. Here are six policies from around the world that could make childbirth safer for women everywhere.
1) Dig into data
Designing policy to reduce maternal mortality rates depends on understanding what the causes of death are, all the way from the hospital bed through to macro-social problems like inequality, substance abuse and intimate partner violence.
The California Maternal Quality Care Collaborative is one example of how to translate data into action. The working group, housed at Stanford, collects precise data on what causes maternal deaths; examines available evidence to devise solutions; and then works with hospitals to implement proposed changes.
California State cut its maternal mortality rate in half between 2006 and 2013 thanks to these data-informed fixes. Discovering that haemorrhage was its biggest killer, hospitals created four-wheeled ‘haemorrhage carts’ stocked with necessary supplies to stem the bleeding.
2) Intervene early
Only 63% of women in the global south received at least four antenatal care visits while pregnant — and in Africa, that figure falls to just 51%.
Antenatal care helps to identify potential complications early and avoid fatalities during childbirth. Investing in antenatal care isn’t cheap: while cities can provide centralised services, some rural areas will require more costly and time-consuming home visits by roving specialists. Or in countries where antenatal care costs can deter women from accessing services, Zimbabwe’s approach to providing healthcare vouchers for the poor could encourage uptake.
3) Invest in midwives
Millions of rural women live in areas with no hospital access. Others prefer to give birth at home. For both, governments need to invest in services that go to the user.
In Mexico, many indigenous women refuse to give birth in hospital settings. Some are fearful of the medical establishment; some dislike rules that forbid a partner or family member being present during childbirth; and some prefer to give birth standing or squatting, rather than lying in a hospital bed.
Investing in community-based midwives has reduced maternal mortality rates and kept the prevalence of caesarean sections below its 15% target while allowing women to give birth in settings where they feel most comfortable.
4) Make abortion safe
Some 13% of maternal deaths worldwide are due to unsafe abortions. That’s 67,900 maternal deaths annually.
Safety is closely bound to the legality and accessibility of abortion. Research from [2014](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17%2931794-4/fulltext) found that in countries where abortion is illegal or limited to women whose physical or mental health is at jeopardy, only one quarter of abortions were deemed safe. In countries where the practice is legal, that figure jumps to 87%.
Legal, regulated and accessible contraception and abortion services, combined with robust aftercare, could save tens of thousands of lives.
5) Close the race gap
Sharp declines in maternal mortality rates in the global north haven’t benefited all women equally. In New York City, black women are three times as likely as white women to die during childbirth and 12 times as likely to die from pregnancy-related causes.
The New York City Health Department is addressing racial inequality in childbirth outcomes through more targeted home-visit programmes and sending ‘doulas’ – non-medical accompaniers who provide emotional support during birth — to communities where birth outcomes are worst.
Understanding the different challenges faced by different ethnic and socioeconomic communities and designing policies to suit them will be key to achieving lower death rates across the board.
6) Empower women
Educating women is a human rights priority regardless of the manifold economic and social benefits it affords a society, but it could also significantly reduce maternal mortality rates.
Research using data from 373 health care institutions in 24 countries found that maternal mortality rates among women with low education levels were approximately twice that of educated women.
Helping women to understand health risks, best care practices, the need for ante and postnatal care and how to access services could drastically lower the number of deaths worldwide.
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