Maternal Health Innovations and Urbanization

Abstract

In 2014, nearly 300,000 women around the world will die from causes attributable to pregnancy and childbirth. An estimated 99 % of these maternal deaths occur in low- and middle-income countries. Most of these maternal deaths are caused by postpartum hemorrhage (PPH), infection, unsafe abortion, eclampsia, and obstructed labor. In stark contrast, in well-resourced settings, complications of pregnancy can usually be prevented or addressed successfully without death or disability to the mother (Maternal Mortality [Internet]. WHO; 2012 May [cited 2014 January 01]. http://www.who.int/mediacentre/factsheets/fs348/en/). The major determinants of this enormous disparity in maternal survival are social, economic, and physical barriers to accessing quality healthcare.

The term “urban health advantage” refers to the general observation that health indices in urban settings are often better than in rural areas due to physical proximity of healthcare facilities. However, with close examination, it is clear that the degree of poverty is more predictive of access to healthcare than actual geographic distance between patients and healthcare facilities (Gabrysch and Campbell, BMC Pregnancy Childbirth 9:34, 2009). Despite proximity, the urban poor often have limited access to healthcare and receive lower quality services because of their inability to pay (Harpham, Health Place 15:107–116, 2009; Matthews et al., PLoS Med 7(9):e1000327, 2010). Additionally, the urban poor in high-density settings often suffer from low-quality public and private healthcare services, consequently disincentivizing desirable prevention and care-seeking behaviors of the population.

Novel, low-cost solutions are required in order to overcome the challenges unique to the growing phenomenon of global urbanization. This chapter will provide an overview of promising innovations in maternal health via two themes: (1) increasing mothers’ access to care, discussed in relation to the “Three Delays Model” (Thaddeus and Maine, 38:8, 1994), and (2) improving quality of maternal healthcare, with a particular focus on addressing the major causes of global maternal mortality. In time, these innovations and others may become long-term solutions or may be replaced by new ideas. The innovations described in this chapter are examples of what is indeed possible with fresh and creative approaches that are focused on saving the lives of our future mothers.