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.

To read the report from Day 1 click here.