The writer is chief executive of the Access to Medicine Foundation
In 1934, Kaveri, a 19-year-old girl in Malaya, died of severe bleeding after giving birth to a baby boy. She was my grandmother. My father grew up motherless while my grandfather toiled round the clock in a rubber plantation.
Nearly a century later, the international community has committed to consigning such avoidable deaths to history. Yet progress has stalled, leaving vulnerable women and newborns around the world at the mercy of broken healthcare systems and without access to life-saving medicines.
The evidence is plain to see. A woman dies somewhere in the world every two minutes during pregnancy or childbirth, and each day more than 6,000 neonatal babies die within their first four weeks of life. This unacceptable death toll is especially high in sub-Saharan Africa.
But it doesn’t have to be this way. As of 2020, there were around 30 countries where maternal and newborn deaths were still falling, showing that progress is possible. However, mortality rates in the majority of resource-poor countries have stagnated or gone backwards. While the UN’s sustainable development goals set a target of no more than 70 maternal deaths per 100,000 live births by 2030, the global ratio remained three times above that level at 223 per 100,000 in 2020.
So, what is going wrong? In the case of post-partum haemorrhage (PPH), the condition that killed my grandmother, the World Health Organization has issued comprehensive guidance on prevention and treatment. Yet far too often this is not translated into practice on the ground. We need to improve access to oxytocin, the first-line treatment for severe bleeding, and train health workers to administer treatment and protect mothers from such preventable deaths. PPH still causes about 70,000 deaths every year and many survivors are left with serious disabilities and psychological trauma.
Women’s health must become a far higher priority on the global healthcare agenda. Severe bleeding, high blood pressure, pregnancy-related infections, unsafe abortion, and conditions such as HIV or malaria that can be aggravated by pregnancy are among the leading causes of maternal deaths — even though they are largely preventable or treatable. Many lives could be saved if mothers received simple, low-cost interventions such as antibiotics and drugs to manage complications of labour.
Pharmaceutical companies also have a key role to play in providing affordable access to these essential products. The global industry’s response to date has been inadequate and fragmented. These firms have the products, the means and the market presence to take action at scale. They also have the scientific knowhow to find innovative new ways of delivering treatment. They now need to put these resources to work.
The case of post-partum haemorrhage highlights both the challenge and the opportunity. The standard treatment is oxytocin, and many lives could be saved by improving generic supplies of this medicine — whether from multinational companies or, even better, by making more drugs locally in factories in Africa and other resource-poor regions.
More research is also needed to find heat-stable versions of oxytocin and simpler ways of administering the drug, which currently requires intravenous or intramuscular injection by skilled healthcare workers.
Similarly, more must be done by the global health community to ensure that a full spectrum of appropriate antibiotics is available, especially given the rise in antimicrobial resistance. Oral and injectable antibiotics are essential in dealing with multiple infections, including the risk of life-threatening sepsis following childbirth or congenital syphilis, a condition that leads to many stillbirths in Africa.
In some cases, outdated attitudes stand in the way of better maternal care. Misoprostol, for example, is a drug with many uses, including the management of miscarriage, induction of labour, cervical ripening before surgical procedures, and the treatment of post-partum haemorrhage. It is cheap, does not require refrigeration and can be given by a non-physician healthcare worker. But the fact that it can also be used to cause abortion too often stalls its integration into routine obstetric care.
We can make the difference between life and death for millions of women and babies globally. If we as a society are serious about women’s rights, then pharmaceutical companies and the wider global health community must ensure that mothers in the 21st century have a better chance than Kaveri of bringing their babies safely into the world.
