Lesson 2 Maternal Health Issues

As stated previously, maternal health is fundamental for the smooth course of pregnancy. Maternal health includes antenata care (care during pregnancy), care in labour and postnatal care (care after labour). Every step of the process is important and should be handled carefully in order to ensure the health of both the mother and the newborn and give the baby the opportunity to thrive and reach its fullest potential.

The reasons behind maternal mortality are often complications which develop during pregnancy. The majority of them are preventable and treatable.

  • Severe bleeding (mostly bleeding after childbirth)
  • Infections (usually after childbirth)
  • High blood pressure during pregnancy (pre-eclampsia and eclampsia) 
  • Complications from delivery
  • Unsafe abortion

Additionally, infections like malaria or chronic cardiovascular diseases or diabetes can impact the health of the mother and exacerbate the risk of maternal death.

According to World Health Organization (WHO) ending preventable maternal death is one of the top priorities globally.

According to WHO, approximately 810 women die every day from preventable causes related to pregnancy and childbirth. Therefore, the identification of preventable causes is of great importance. 

  • Delays in seeking medical advise
  • Refusal of medical interventions
  • Lack of adequate surveillance of intrauterine growth restriction
  • Insufficient medication
  • Lack of interpersonal communication

In this lesson we will analyse the following terms:

Maternal Care

Maternal Mortality

Maternal Mental Health

Accessibility and Quality of Healthcare Services

Maternal Care

Maternal Care is very important for you as various complications can be recognised and treated early on, in order to avoid further problems. However, some populations have greater risks in developing certain complications.

  • Gestational Diabetes
  • Eclampsia
  • Anaemia
  • Mental Health issues like postpartum depression, due to poor health alongside with burdens in the integration process.
  • Abortion
  • Preterm delivery
  • Pre-eclampsia / eclampsia
  • Gestational diabetes

Nevertheless, it is important to understand that women should not be thought as a homogenous group because there seem to be many differences among them which depend on their origin and certain biological and genetic features.

Maternal Mortality 

Maternal mortality refers to death of women during pregnancy, childbirth or the first 42 days after delivery.

Several studies show that refugee and migrant women have higher mortality and morbidity rates during pregnancy compared to women from the host country. 

  • Hypertensive disorders (primarily preeclampsia and eclampsia)
  • Deep vein thrombosis
  • Pulmonary embolism.

Find maternal mortality data in your country

Socioeconomic status is also considered a risk factor for maternal mortality. Some low-income countries have more than 100 times the maternal mortality ratio of high income countries caused by pre-eclampsia or eclampsia, anesthesia-related problems, obstetric complications, or caesarean section difficulties.

Check Maternal Mortality data by income group 

  • Low income
  • Difficulty in transport 
  • Poorly equipped rural hospitals
  • Socioeconomic factors like unstable and harmful work conditions, low educational level, increased rates of violence and lack of permanent residency 
  • Social exclusion, discrimination, multiple losses and chronic stress
  • Lack of communication between providers and patients due to cultural differences, limited understanding and access to supportive services
  • Higher prevalence of diseases like HIV or heart disease in sending country 
  • Biological and genetic features that predispose to certain illnesses like thalassaemia
  • Poor antenatal care

You can notice that some of these factors are physical but the majority are socioeconomic. You should focus on attending to the physical ones as the others are the responsibility of well-functioning nations with humanitarian principles. 

Maternal mortality is a devastating outcome that should be avoided in any way possible. Please click on the following link to learn more about it : Maternal Mortality (WHO) 

Routine/Preventive Doctor Visits 

You can notice early on all these common conditions by frequently visiting a healthcare professional. Prompt identification improves treatment outcomes and avoids further complications. 

  • Decision to arrange a doctor appointment
  • History taking, physical examination, blood tests
  • Consultation on any concerns about health and wellbeing in general
  • Receiving results
  • Suggestion of proper treatment (if necessary), usually through oral medication
  • Arrangement of future visits for follow up examination

Maternal Mental Health 

Mental health issues are more frequent than you imagine! As we grow up we think that pregnancy is only a positive event where you get to experience the miracle of life! While this is certainly true, you should never forget that during the perinatal period your body changes physically and emotionally, new worries come to mind and all in all it is a brand new pathway that you as a parent, are walking in. Therefore, there is high possibility that you might experience some negative feelings, alongside with the positives one. But be careful because if this feelings are growing and start affecting your life, then you are probably experiencing a mental health issue. Do not be afraid as approximately one in five women develop perinatal mental health problems!

  • Perinatal depression (antenatal and postnatal)
  • Perinatal Anxiety
  • Perinatal Obsessive Compulsive Disorder (OCD)
  • Postpartum Psychosis
  • Postpartum Post-traumatic stress disorder (PTSD)

Postnatal depression has the highest frequency of all mental health issues. If left untreated, postnatal depression can affect your everyday life and can even lead to suicide. Also, children of depressed mothers, more frequently experience poor physical, cognitive and emotional outcomes. 

Source: https://pixabay.com  

  • Pre-existing psychological issues
  • Poor health status
  • Feeding issues 
  • Socioeconomic struggles and the stressors that come along, like living in overcrowded accommodation, domestic violence, harsh working conditions, unintended pregnancy and inadequate social support.
  • Problematic integration in the host country (for migrant/refugee women)

Source: https://unsplash.com 

  • Internalisingsymptomsand disorders like depression and anxiety 
  • Poorsocialand emotional skills 
  • Insecureattachment
  • Linguisticand cognitive impairments

Paternal Mental Health in migrant/refugee families

  • A special mention should be made regarding the mental health status of migrant/refugee fathers. 
  • They have to deal with the majority of the aforementioned harsh conditions alongside with the traditional responsibilities of protecting and supporting the family. In addition, they too directly influence the growth and development of their children.
  • Studies have shown that refugee men are at high risk of developing a range of psychological and physical conditions :
  • PTSD
  • Depression
  • Anxiety
  • Musculoskeletal Disease
  • Respiratory Disease
  • Cardiovascular Disease
  • Infectious Disease

Therefore, fathers should also visit the doctor regularly and keep in mind that them being healthy means supporting their child whenever in need!

If you want to learn more about mental health, please refer to Module 5: Mental Health

Accessibility of Healthcare services 

Accessibility to perinatal healthcare services is often difficult for women. Perinatal care includes routine care and specialist care. Access to perinatal healthcare can identify and therefore prevent adverse perinatal outcomes.

  • Lack of awareness, knowledge and guidance about when, where and how to visit a healthcare facility
  • Misconceptions
  • Personal beliefs about risk and safety
  • Lack motivation  
  • Economic struggle (direct and indirect expenses) 
  • Fear of medical intervention in childbirth for many different perceived and practical reasons
  • Migration (e.g. communication barriers)

Quality of care 

Poor quality of care is a major reason that force women away from healthcare facilities and thereby indirectly results in perinatal complications. Conditions like long waiting times and lack of sufficient workforce in health facilities are negatively affecting women attendance. Additionally, lack of healthcare personnel creates more gaps in the visit or delivery process. 

Find out the global delivery care coverage and trends

In addition, studies revealed that certain behaviours towards marginalised populations like migrant women worsen the quality of care. Refugee and migrant women reported complaints about delay in the diagnosis and treatment of pregnancy complications and the discontent about lack of respect and understanding and discrimination during their visits. Prejudice and stereotyping by healthcare professionals make women feel overlooked due to cultural and psychosocial factors.

How to cope with lack of accessibility and low quality of care?

  1. You can contact friends, family or local authorities in order to learn what local healthcare services are available to you. If you get caught in paperwork and regulations do not hesitate to ask for more guidance.
  2. You can always attend the scheduled visits with a family member or a friend in order to feel more comfortable and secure. If you have any communication barriers, do not hesitate to ask for a translator or have a someone with you that can help you out.
  3. Do not be discouraged by the financial struggles which you will might have to face during your contact with healthcare services. The majority of healthcare systems offer services regardless patient’s financial capability. In addition, you can look for organisations that offer medical and other services to populations that have limited access to medical care.
  4. It is possible that you come across with the aforementioned mistreatment, therefore you should be well-equipped with patience and persistence in order to find a healthcare profesional who will stand up to your expectations. Bearing with disrespectful behaviours has nothing to offer and will only lead you to distance yourself from the healthcare community. If you struggle finding the proper health profesional, feel free to submit an official complaint to the local authorities.
  5. Assessing the quality of services should be a major priority, but always keep in mind that what matters the most is not the infrastructure but the preparedness, the attitude and the experience of the healthcare personnel that is going to be your guide through the whole process. 
  • Source : https://unsplash.com
    Age below 20 years
  • Economic struggle
  • Single mothers
  • Unplanned pregnancy
  • Low educational level 
  • Lack of health insurance 
  • Having several children
  • Cultural differences 

*Cultural differences can pose an obstacle on accepting practices pre, post and during pregnancy that are against their beliefs. These factors can lead to social isolation and therefore increase the risk of adverse  perinatal outcomes.

If you belong in any of these categories, please be extra alert for any signs of negative feelings towards healthcare services. You should always keep in mind that no matter your age, your social and financial background or your ethnicity, you and your child deserve a healthy and prosperous future!

You should always keep in mind that nowadays digital health services are also available in the majority of countries. Digital health options might be more easily accessible, as they circumvent language, transfer and financial impediments thereby providing a great alternative to traditional health consultation.

Have a look on your country’s online health resources and find out about the availability of such tools.  

Source : https://pixabay.com