Designing better solutions for maternal health

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By Bjorn Lomborg

Every two minutes, a pregnant woman dies from preventable complications related to childbirth, one of the most beautiful moments of human life. Mothers in developing countries are disproportionately affected by this tragedy, with a risk of dying in childbirth 80 times higher than their rich country counterparts. Infections, seizures caused by high blood pressure during pregnancy, and severe bleeding after childbirth are considerable risks for these mothers, many of whom give birth in their homes or in facilities with limited basic emergency care and poor hygiene.
Maternal health has long been a global priority, included in the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs). However, the objective of reducing the global maternal mortality rate (MMR) by three quarters from 1995 has not been achieved. Between 2000 and 2017, maternal deaths declined by 45%, from 451,000 to 295,000, but the decrease fell short of the global MDG target by approximately 135,000. Further still, the 2015-2030 SDGs establish a global MMR goal of 70 per 100,000 births in 2030. As recently as 2017, global health systems still don’t appear to be on track to meet this goal, with the actual MMR being three times higher.
Investing in maternal and newborn health has far-reaching consequences years and even decades into the future. The death of a mother weighs heavily on a family, and the lives of surviving children are bleak – their risk of dying before the age of 5 can be up to 51 times higher. Households also see a reduction in income following a maternal death, and children often need to support the family, which cuts their education short. Investments in maternal and newborn health can help lessen the instances of maternal deaths and contribute to a cycle of growth and progress for the women, their families and communities.
Something needs to be done. An analysis presented at the UN Population Summit in Nairobi in 2019 documented the cost of a package of interventions to end preventable maternal deaths, eliminate gender-based violence and meet the family planning needs of women in 120 countries. While this package is necessary and commendable, its additional global funding cost of more than $30 billion a year makes it implausible to be funded, either by cash-strapped governments or squeezed donor programs. Low- and middle-income countries with limited budgets need to strategically target interventions in a manner that helps them end preventable maternal deaths using the smartest policy options available.
A new report by the award-winning think tank Copenhagen Consensus, supported by funding from Merck for Mothers, uses the proven method of cost-benefit analysis to define the policies that would do the most good for every dollar spent, providing an evidence-based approach to end preventable maternal deaths. Using Johns Hopkins University and Avenir Health’s LiST model, the study analyzed the potential effect of more than 30 different targeted interventions in the 59 countries with the highest maternal and newborn mortality rates. These countries represent roughly half of the world’s population, including 970 million women of reproductive age.
The findings of the study revealed that a package of Basic Emergency Obstetric and Newborn Care (BEmONC), comprised of 15 primary health-based interventions including routine delivery care, administration of antibiotics, assisted vaginal delivery and neonatal resuscitation, was among the most cost-effective interventions packages. Scaling up the implementation of BEmONC to cover 90% of the unmet need would require an additional $2.2 billion per year in investments, but would help avoid an expected 93,000 maternal deaths, 870,000 newborn deaths and 810,000 stillbirths, generating $61.5 of benefits for every dollar spent.
The researchers also studied the effects of safe and inclusive family planning, which has the potential to save 87,000 women’s lives annually. This intervention would generate $27 worth of social benefits for every dollar spent by governments and beneficiaries, costing an additional $1.2 billion per year. Having fewer children also allows women to be more active in the labor market. Children will have more access to their parents and teachers and can become more productive as adults, fueling economic growth.
A combination of these two interventions, however, was the package with the greatest potential to save lives per dollar available. Basic emergency obstetric care together with family planning could lead to 162,000 fewer maternal deaths, 1.21 million fewer newborn deaths and 1.18 million fewer stillbirths each year. The combined package could be produced at a cost of $2.9 billion per year and has the potential to provide $71.5 in benefits per every dollar invested by governments. For resource-constrained nations, this intervention can provide the greatest benefit for each dollar spent.
The researchers also found that grouping interventions together increases their benefits and lowers the likelihood of complications throughout and following the pregnancy, as well as their cost of administration. While there is no magic bullet to reducing maternal mortality, these types of broad packages of interventions, especially those that include family planning, are a pathway to reaching the global goals in maternal health at a fraction of the cost usually projected. Investing in sexual and reproductive health care could help generate hundreds of billions of economic and health benefits to households and societies around the world and save millions of lives.

Bjorn Lomborg is President of the Copenhagen Consensus and Visiting Fellow at the Hoover Institution, Stanford University