Maternal health

from Wikipedia, the free encyclopedia

Maternal health (in Austria and maternal health ) refers to the health of women with regard to pregnancy , childbirth and postpartum . Offers to promote maternal health include sex education , family planning , advice on the desire to have children, prenatal care and postnatal counseling for mothers . In the poor countries of the South, schooling and health care are essential to maternal health and are essential to reducing maternal mortality . But even in developed countries, educationally and socially disadvantaged mothers and their children are in poorer health.

Poor maternal health has serious effects on the child's health and development. Poverty, malnutrition, physical and mental illnesses impair mental (cognitive), physical (motor), mental and emotional (behavioral) development throughout childhood. If the mother's health is severely impaired during pregnancy, the child is likely to develop health and development problems, and in the worst case scenario, infant death. The physiological environment that the mother provides for the embryo and fetus is critical to its well-being long after birth.

Healthcare offers consist of screening and other interventions for women of childbearing age and aim to reduce the risk of pregnancy. Pregnancy complications should be prevented or discovered as early as possible. Professional midwives can intervene in the event of complications of childbirth. After childbirth , maternal counseling helps with recovery from childbirth, baby care and feeding ( breastfeeding counseling) and advice on family planning issues .

Factors affecting the health of both mother and child

Poverty and lack of access to medical services

The risk of dying during pregnancy or childbirth is 175 times greater in Sub-Saharan Africa than in developed countries, the risk of pregnancy diseases and negative consequences after childbirth is even greater. Poverty, maternal health and the chances for the child are closely related. First week deaths in developing countries account for 98% of global deaths of this age. In 2010, 287,000 women worldwide died during pregnancy or childbirth. Poverty is detrimental to the health of both mother and child.

A study conducted in Kenya showed that common maternal health problems in poor areas include bleeding, anemia, high blood pressure, malaria, placenta retention, premature labor, prolonged / complicated childbirth and preeclampsia. Proximity to facilities and the availability of transportation can have a significant impact on whether or not prenatal care is used. In Mali, a study of maternal health services found that women who lived in rural areas far from health facilities were less likely to receive professional care during pregnancy and childbirth than those in urban areas. A lack of transportation was even more important than where you lived alone. A study in rural Ethiopia showed similar results.

In general, appropriate prenatal care includes medical care, but also education, social services and ensuring adequate nutrition during pregnancy. In developed countries, too, women who live in poor areas are more likely to be overweight, more likely to have unhealthy behaviors such as smoking and drug use , to take less prenatal care or to have poorer access to it. They have a significantly higher risk of negative consequences for mother and child. There are a number of reasons women might not take prenatal care. In an American study, 71% of low-income women had difficulty accessing prenatal care. In the US, immigrant and Hispanic women are at higher risk than white or black women of receiving little or no care. The level of training is also an indicator. American adolescents are the least likely to receive benefits during pregnancy. In several studies, women and adolescents cited a lack of funds and a lack of transport options as the most common barriers to receiving pension benefits. The quality of pension benefits is strongly related to income.

HIV / AIDS

Maternal HIV rates vary between 1% and 40% worldwide. The African and Asian countries have the highest rates. HIV can be transmitted to the child during pregnancy, childbirth or breastfeeding, and most often it is transmitted during pregnancy. An infected mother has about a 25% chance of transmitting the virus to the child if she does not receive adequate antiretroviral treatment. However, if it is treated during pregnancy, there is a 98 percent chance the child will not get infected.

According to UNICEF reports , the number of children who have died of HIV / AIDS has risen sharply in the last ten years, especially in countries where poverty is high and the level of education is low. Although various preventive measures would be possible, the high costs and the lack of infrastructure are two central problems that international organizations have to contend with if they want to combat mother-to-child transmission of HIV in developing countries. Pregnancy with HIV infection is also an even greater risk for the mother in developing countries. B. to contract tuberculosis or malaria.

Obesity

Body weight should increase by around 10 to 15 kg during pregnancy. Maternal obesity can lead to increased blood pressure, diabetes, respiratory complications, and infections, and can adversely affect the course of pregnancy. Being very overweight is a major risk factor for gestational diabetes . This in turn leads to the birth of very heavy infants, to obesity in the child and later to type II diabetes .

Malnutrition

The nutrition of the embryo and fetus is based on the maternal protein, vitamin, mineral and total calorie intake. Children of malnourished mothers develop less and as a result of this growth retardation are smaller, lighter and weaker at birth and are more likely to show malformations. Brain development in particular can be impaired. In addition, maternal stress can directly and indirectly affect the fetus. Physiological changes under stress affect the developing fetus.

depression

Motherhood and parental responsibilities can be extremely stressful, especially when material and social conditions are unfavorable. In turn, maternal mental illness can be a significant burden for children. In the US, statistics show depression in 10% of all mothers; the proportion is even higher for economically disadvantaged mothers.

Drugs, tobacco and alcohol

Newborns whose mothers use heroin during pregnancy often experience withdrawal symptoms at birth and are more likely to have attention disorders and other health problems later. The use of stimulants such as methamphetamine and cocaine during pregnancy is linked to a number of problems for the child, such as low birth weight, small head circumference, motor and cognitive developmental delays, and behavior problems in childhood.

The American Academy of Child and Adolescent Psychiatry found that 6-year-olds whose mothers smoked during pregnancy did less well on an intelligence test than children whose mothers did not smoke. Smoking during pregnancy can have a variety of adverse effects on the child's health and development. Common consequences of smoking during pregnancy are premature births, low birth weights, fetal and neonatal deaths, respiratory diseases and sudden infant deaths, and an increased risk of cognitive disorders, attention deficit hyperactivity disorder (ADHD) and other behavioral disorders. A meta-analysis in the International Journal of Cancer shows a 22% increase in the risk of non-Hodgkin lymphoma for children whose mothers smoked during pregnancy .

Although moderate consumption of alcohol (one or two glasses on individual days per week) during pregnancy has not been proven to have any harmful effects, it is generally not recommended to consume alcohol during pregnancy. Excessive alcohol consumption during pregnancy can lead to fetal alcohol syndrome, with physical and cognitive abnormalities in the child, such as deformities of limbs, face and heart, learning problems, below-average intelligence and even intellectual disability.

Dental health

Maternal dental health affects the well-being of mother and (unborn) child. The 2000 report by the Surgeon General , director of the United States Public Health Service , emphasizes the interdependence of dental health and overall health. Dental health during pregnancy affects the future development of the child. The report names a wide variety of diseases that affect dental health and vice versa, such as diabetes, cardiovascular diseases, stroke and pregnancy complications are associated with dental health, including quality of life, functional, psychosocial and economic indicators. Poor dental health has a negative impact on diet, sleep, social relationships, school, and work. Pregnancy changes the physiology of the woman, the hormone levels and the immunological reactions, and thus also causes an increased susceptibility to diseases of the connective tissue of the tooth supporting apparatus ( periodontium ).

Dental caries is transmitted vertically from mother to child through the exchange of saliva with the bacteria it contains. The maternal oral flora is transmitted to the offspring. Social and behavioral habits as well as a lack of knowledge of dental care are also transferred to the child and influence their future dental health. Compared to children whose mothers have good dental health, children born to mothers with poor dental health are five times more likely to have bad teeth themselves. Despite the importance of dental health, many pregnant women do not receive adequate dental care, even with obvious dental problems.

Teratogens

A teratogen is an external factor that can cause malformations in the embryo. Chemicals, viruses, and ionizing radiation can lead to a birth defect or affect the child's development. Dose, genetic susceptibility, and timing of exposure are all factors that determine the extent of adverse effects. Prescription drugs taken during pregnancy such as streptomycin , tetracyclines , individual antidepressants , progestin , synthetic estrogen and Accutane , as well as over-the-counter drugs such as: B. diet pills can have a teratogenic effect. Even high doses of can ASS lead to maternal and fetal bleeding, although low-dose aspirin should not hurt.

Herpes

Genital herpes is transmitted to the child through the birth canal at birth. In pregnancies where the mother is infected with the virus, 25% of children get brain damage and a third die. In developed countries, mothers with genital herpes and HIV often choose cesarean delivery to avoid the risk of transmitting the virus. This option is mostly not available in developing countries.

Breastfeeding

→ See also main article: Breastfeeding: Benefits and Risks

After the birth, the mother breast-feeds the baby if she wishes and can. Breastfeeding has many benefits for the infant. The World Health Organization recommends that mothers breastfeed their infants for the first two years of life, while the American Academy of Pediatrics and American Academy of Family Physicians recommend that mothers do so for at least the first six months and continue with it for as long as mutually desired. Infants who are breastfed are less prone to infections with e.g. B. Haemophilus influenzae , Streptococcus pneumoniae , Vibrio cholerae , Escherichia coli , Giardia lamblia , B- streptococci , Staphylococcus epidermidis , rotavirus , respiratory syncytial virus and herpes simplex virus 1 , for infections of the gastrointestinal tract and the lower Respiratory tract as well as otitis media. Breastfeeding babies have lower rates of cot death and overall infant mortality. Metabolic and cancer diseases are also rarer.

Breastfeeding also offers long-term benefits for women. It has been shown, for example, that women who breastfeed for a long time have a significantly reduced risk of developing ovarian cancer. Also on breast cancer diagnosed women who breastfeed for a long time, slightly less often than women who feed the bottles food. Many other beneficial effects on maternal health that have been attributed to breastfeeding in the past, such as: B. an accelerated return to the original body weight, but are now considered measurement artifacts from methodologically problematic studies that have systematically excluded possible factors other than breastfeeding (e.g. eating habits).

However, transmission of HIV through breastfeeding is a huge problem in developing countries , particularly in sub-Saharan Africa. The majority of children who acquire HIV from breast milk do so in the first six weeks of life. The virus is also a leading cause of maternal mortality, especially in mothers who are breastfeeding. One complication is that many HIV-infected mothers cannot afford bottle-fed food and therefore have no way of preventing the virus from being transmitted to the child. In cases like this, mothers have no choice but to breastfeed their children regardless of their knowledge of the harmful effects.

Long term effects on the mother

Mother and child consultation hours in Afghanistan

In many developing countries, complications of pregnancy and childbirth are the leading cause of maternal mortality (death of women of childbearing age). Around the world, a woman dies of childbirth complications every minute. According to the World Health Report 2005 of the World Health Organization , poor maternal health is the fourth leading cause of death for women worldwide, after HIV / AIDS, malaria and tuberculosis.

Most maternal deaths, injuries, and illnesses are caused by biological processes, not disease; they can be prevented and have been largely eradicated in the developed world, such as postpartum bleeding , which causes 34% of maternal deaths in developing countries but only 13% of maternal deaths in developed countries.

In developed countries, with the expansion of health care, maternal mortality has become a rare occurrence, with only 1% of maternal deaths worldwide. In the developing world , the simplest complications can often be fatal because the most important factor in ensuring safe motherhood is that a trained obstetrician or midwife is available for each birth is not guaranteed, and transportation to an obstetric center is often not available. In 2008, 342,900 women worldwide died during pregnancy or childbirth. While this is a large number, it was a significant improvement since 1980 when 526,300 women died from the same causes. The improvement was the result of lower pregnancy rates in some countries; higher income, which improves nutrition and access to health services; more education for the mothers; and the greater availability of trained birth attendants - people trained in basic obstetrics and emergencies. The situation has been mainly fueled by improvements in large countries such as India and China, which have lowered overall mortality rates. In India, the government began making payments to provide access to prenatal and obstetrical care. The success was so great that India is considered the main reason for the decline in maternal mortality worldwide.

Birth complications do not always lead to death, but 20 times more likely to lead to health problems such as infection , injury and disability . Still 50% of women in developing countries give birth without a medically trained obstetrician, the proportion is even higher in South Asia. Sub-Saharan women rely mainly on traditional obstetricians with little or no formal medical training. Some countries and non-governmental organizations, aware of their traditional roles, are making efforts to educate them on maternal health issues in order to improve health opportunities for mothers and children.

Maternal mortality

Maternal mortality rate worldwide (number of maternal deaths per 100,000 live births ) for all causes of death related to pregnancy, excluding accidents or independent causes of death.

The US Joint Commission on Accreditation of Healthcare Organizations describes maternal mortality as an indicator of the quality of health care and uses it for its evaluation.

Maternal mortality data are considered an important indicator of the quality of health care because pregnant women survive in hygienic, safe, well-staffed and equipped facilities. When young mothers are doing well, it means that the health system is doing its job. If not, problems likely exist.

According to Garret, reducing maternal mortality is an important goal of the world health community because it shows that other health concerns are also improving. The improvement in health has a positive effect on the whole population.

Maternal mortality has decreased worldwide, most notably in Southeast Asia with 59% and in Africa with 27%. But no region will be able to achieve the Millennium Development Goal of reducing maternal mortality by 75% by 2015.

International programs to improve maternal health

The World Bank estimates that US $ 3.00 per person per year is enough to provide basic health care services for women in developing countries during pregnancy and childbirth. Many non-profit organizations have programs in developing countries to provide information to the population and to promote access to emergency maternity care for mothers. The United Nations Population Fund (UNPFA) launched a Campaign for Accelerated Reduction of Maternal Mortality in Africa (CARMMA) in 2009, with a focus on providing high quality maternal health care. In Sierra Leone, for example, CARMMA offers free health care for mothers and children. The initiative has broad support from African heads of state; it was launched in cooperation with the health ministers of the African Union .

Improving maternal health is the fifth of the eight United Nations Millennium Development Goals . The number of women who die during pregnancy or childbirth is expected to decrease by three quarters by 2015, mainly due to the increased use of qualified obstetrics, contraception and family planning. The current decline in maternal mortality is only half of what it takes to achieve this goal. In some regions, such as sub-Saharan Africa, maternal mortality is even increasing. Reducing maternal mortality and the burden of disease in developing countries is important because maternal poor health is both an indicator of and a cause of extreme poverty.

“Maternal deaths are both caused by poverty and are a cause of it. The costs of childbirth can quickly exhaust a family's income, bringing with it even more financial hardship. "

“Maternal mortality is both a cause and a consequence of poverty. The cost of childbirth can quickly exhaust a family's income and plunge them into financial hardship. "

- Tamar Manuelyan Atinc, Vice President Human Development, World Bank : WHO

In May 2014 the World Health Assembly adopted the “Every Newborn” action plan, further paving the way for national implementation and monitoring of key strategic measures to improve the health and well-being of newborns and their mothers around the world. The program is supported by the Federal Ministry for Economic Cooperation and Development .

Developed countries until the early 20th century had maternal mortality rates similar to those of the developing countries in the early 21st century. In the 19th century, the Swedish government began a public health program to reduce the death rate to less than 300 per 100,000 live births. Enough midwives have been trained to be able to attend to all births. This approach was later implemented by Norway, Denmark and the Netherlands with similar success.

The increasing use of contraception and family planning improves maternal health, mainly by reducing the number of pregnancies, each of which is a risk to the woman. In Nepal, there was strong emphasis on the provision of family planning in rural areas, which was found to be effective. In Madagascar, contraceptive use increased from 5.1% in 1992 to 29% in 2008 following the introduction of a nationwide family planning program.

See also

Web links

International organizations

Scientific literature and data

US and international aid and advocacy organizations

Other English language sites

German-language pages

Individual evidence

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