The sharp and sustained focus on maternal health over the last 30 years has paid off: significant progress has been made in improving the health of women during pregnancy, labor and delivery, and the post-partum period. The most obvious indicator of these achievements is the global decline in maternal mortality by 45% since 1990. But our work on maternal health is far from over, as averages hide important inequalities among women from different geographies, cultures, and socio-economic groups.
The major epidemiological transition and health systems transformations happening around the world bring about new challenges and opportunities and underscore the importance of a more integrated vision of women’s health. As women worldwide bear growing burdens of chronic and non-communicable diseases (NCDs), efforts that look at the causal thread determining and undermining health during the different stages of the life cycle are increasingly important. It is time to revisit our approach to maternal health needs so that we can effectively address both the complex unfinished and emerging maternal health agendas.
We need to rethink maternal health in the following ways:
- Consider precipitating factors of maternal death to look at indirect causes and social determinants of health,
- Extend the outcomes of maternal health initiatives beyond survival to wellness and attainment of highest achievable level of health. The maternal health field should encompass the whole reproductive continuum of care, including the women who face complications in their efforts to get pregnant or as a result of unsafe abortion and miscarriage,
- Expand the focus on maternal health beyond pregnancy and birth to look at the long term value of mothers to families and communities and the enduring cost to children and society when a mother dies, and
- Widen the scope of women’s health beyond maternity to reflect women’s full value as contributing members of families, communities, societies, and economies.
These priorities are at the core of the Strategies toward Ending Preventable Maternal Death (EPMM) seminal document, consistent with the “obstetric transition” model proposed by JP Souza and others, and reflective of the comprehensive view of women’s health outlined in the report of the Lancet Women and Health Commission.
Broadening our vision for maternal health in these ways will take us farther on the path to ending preventable maternal deaths and bring us closer to achieving the sustainable development goals.