Soroptimist International’s Programme Director, Reilly Dempsey, is attending the 10th World Congress on Maternal and Neonatal Health in Rome. Here is her report from the second day of events, seminars and debate: 

Today the sessions were quite varied, ranging from very technical clinical studies, to new technologies and techniques, to successful community based intervention and policies.

For SI work, three messages came through loud and clear.  Let’s introduce all three then we’ll look in a bit more detail. First, the risks associated with C-sections and the growing “epidemic” of rate of C-section.  Second, the critical importance of family planning and contraception.  Third, the fascinating relationship between pregnancy and non-communicable diseases.

The epidemic of C-Sections

Clinically, we normally expect to see about 15% of pregnancies result in a C-section, either planned or in an emergency due to certain medical indications.  But in many countries, the rate of C-section is more than 50%!  The reasons for this may be a bit subjective and anecdotal. For example, doctors wanting to schedule deliveries for easier working schedules, women being “too posh to push”, it is a very easy procedure to do – sometimes perceived as easier than a normal vaginal delivery.  There is also quite a difference between incidence in public hospitals (lower) and private hospitals (higher).  But C-sections are most definitely not without risks.  Clinically, many different studies showed that C-sections done without medical indication carry risks which should not be ignored.  It is the responsibility of the medical community, and obstetricians particularly, to ensure that C-sections are done only when medically necessary.

Family planning – the magic bullet?

Second, the importance of family planning in reducing maternal death and disability.  This point was stressed as being particularly important in countries with very high fertility which also happen to be countries which also tend to be most vulnerable to climate change, hunger, poverty, and conflict  (often in that order).  In these countries, it is absolutely vital to increase use of modern contraception to reduce needless maternal deaths.  Above and beyond saving women’s lives, increasing family planning is necessary to avoid widespread famine (where women and children suffer the most).  Notably, even for women who choose to have a large family (4+), family planning is still necessary to allow for spacing between births to protect the health and development of both the mother and the children.

According to Malcolm Potts, a scholar working at Berkley in the USA, voluntary family planning is powerful but not happening.  In some countries, unmet need outstrips usage of modern contraceptives.  This unmet need has a clear impact on maternal mortality.  Yet while we still face huge proportions of unmet need, it is not prohibitively expensive or onerous to roll out.  Did you know that just 2 days of US spending on defence, war, veterans, and nuclear weapons development would pay for ALL of the unmet need in family planning around the entire globe?  We also heard from Mithai Horga from Romania about the dramatic reduction in maternal mortality achieved in his country in the 90s and early 2000s –  due in part to ensuring that women had access to family planning.

Pregnancy and NCDs – a window of opportunity

If you have followed SI’s monthly focus, you will know about the emerging public health crisis of non-communicable diseases and the particular effect on women and girls.  Many new studies are showing a clinical relationship between maternal risk factors, including lifestyle choices, and the onset of NCDs in childhood.  In other words, what a pregnant woman does whilst she is pregnant can and will have a lifetime effect on her baby.  No longer are these diseases just in the Global North. The epidemic is growing most rapidly in Sub-Saharan Africa, the Middle East and North Africa, South East Asia, Central and South America, and the Western Pacific –  and rates are not slowing in Europe or North America.  NCDs have a significant negative impact on sexual and reproductive health, including lower fertility, problems with conception, miscarriages, poor pregnancy outcomes, genital infections, and even vaginal dryness/ dyspareunia/ impotence in men.  Coupled with the fact that a mother affected by NCDs will likely have a baby with health problems the crisis is imminent.  But it is not without hope!  As we work to ensure that pregnant women are within the health care system for antenatal care, we also have the opportunity to screen for certain NCDs and to help pregnant women to protect their health and the health of their babies.  With proper prevention, treatment, and care during pregnancy, we can begin to address the epidemic of NCDs across the world.

Tomorrow (day three) we will be examining issues around infections and pregnancy (including HIV), prematurity and stillbirths.