The Role of Family Planning in Improving Maternal Health

Family is one of the most important elements in a person’s life, according to the Cambridge dictionary family is a group of people who are related to each other, such as a mother, a father and their children. Families also may be connected to other relatives and members. Each family has its own characteristics depending on the community, the background and the area it’s related to. Families and their habits, properties, and elements differ around the world. Any change, whether social, economic, health, educational or any other possible changes on any member of the family may cause change and affect all the other members in the family.

Family health is one of the major aspects that may affect families all around the world, its effects may vary according to the socio-economic situation, culture, health care systems, law, area of living, and other elements. Family health is a very diverse and important topic, it is receiving increasing attention worldwide, because of the wide range of fields it contains and since families are built from members as father, mother, boys, girls, gender aspect is also present concerning health.

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Family health contains psychology, medicine, cognitive development, women's health, children's health, adolescent's health men’s health, nutrition, social issues, and many more. Each one of the mentioned subjects has its own specialties, characteristics, and effects on the family member who is facing a specific situation and further effects on the other family members.

Women's health is one of these important subjects that has been examined, investigated and searched for decades, such as fertility, pregnancy, breast cancer and others.

One topic that has been examined for years and still needs more research, studies, prevention and treatment is maternal mortality. World Health Organisation defines maternal mortality or maternal death as:

“Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”

This subject has influence and effects on the whole family structure, besides the pregnant women, it also affects babies, children, spouses socially, psychologically, mentally, economically reaching to the cultural structure, raising challenges, difficulties and vast changes that need to be dealt with. Maternal mortality is always present when family health topic is raised. When a pregnant mother faces difficulties during her pregnancy, which leads to death leaving a newborn behind her, she leaves an important question behind her as well, why does this occur? how can science, research, and medicine prevent this? What is it connected with? Are there any solutions? how does this affect the general topic of family health? How this loss will affect the baby left behind? How does it affect the rest of the family? Is it connected to genes? is it connected to medical treatment during pregnancy? Is it connected to this mother’s age and living circumstances? Is it connected to culture? What kind of preventive and treatment procedures are used? Will the numbers and statistics connected to it decrease one day? What are the Sustainable development goals related to it? how can they be achieved and when? Are countries dealing with this as an urgent issue? and giving it the attention it should have? All these questions and much more are left behind to think of and find answers.

Maternal mortality definition, reasons, and rates distribution:

Maternal mortality definition is not only the regular definition mentioned above it also has further categories and complementary explanation concerning further cases derived from the pregnancy process, such as A late maternal death which is defined according to the ICD 10 as ‘ the death of a woman from direct or indirect causes more than 42 days, but less than one year after termination of pregnancy’, and “Maternal Near Miss” (MNM) which is defined by WHO as ‘a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy’. Looking at the maternal mortality different definitions and categories by the World Health Organisation and the International Statistical Classification of Disease (ICD 10), and many other organizations that investigate the topic, and understanding further definitions and specifications lead to investigating the factors and reasons that lead to these deaths worldwide.

Moving to maternal mortality causes, there are many direct and indirect causes that lead to maternal mortality with different categories. The majority of the deaths don’t have a fully defined cause, it’s mostly a combination of direct and indirect causes that differ from a woman to another. Approximately three-quarters of the deaths are related to direct obstetric causes, and one quarter is related to indirect causes. The most popular causes of maternal deaths are Hemorrhage, postpartum hemorrhage and anemia, Hypertension and unbalanced blood pressure, infections and sepsis,abortion-related causes and unsafe abortions, depression after delivery. Urine incontinence and other related cause., HIV/AIDS as well as further different pregnancy and delivery complications and specific individual health status and risk factors.

Information, data, and numbers concerning maternal mortality are derived from the hospital's records and reported cases in medical centers about people who seek medical care and treatment, as well as community records derived from studies, surveys, and collected data by the community members which is considered as a poor and limited source of information, because it relies on individual cases reporting which is not considered as a reliable source for documentation and research, in addition to the fact that this kind of limited range studies don’t reflect the existing real situation. According to all this, the information related to maternal mortality is not sufficient or enough to have a full image of this topic, this lack of data makes it hard to understand what takes place in real life, especially in abandoned far areas with poor and limited medical care access and facilities, as well as the wide range of the unreported and unsafe home- deliveries and abortions and complications. As well as the lack of data concerning these women’s diagnosis, background, and medical history.

MMR - Maternal mortality ratio ( number of maternal deaths per 100,000 live births) is considered to be a high mortality rate, with 295,000 deaths during the year 2017, 66.5% occur in Sub-Saharan Africa countries. However, this rate has declined by 38% around the world, between the years 2000 and 2017, according to WHO report 2019. As all maternal mortality evidence, data and prevalence lead to the importance of this issue, it was mentioned as one of the eight goals mentioned by the Millennium Development Goals (MDGs) signed by UN countries in September 2000, to be achieved by the year 2015. Afterward, maternal mortality was also mentioned as one of the first topics in the Sustainable development goals (SDGs) signed by the United Nations in September 2015, these SDGs are expected to be achieved by the year 2030. In relation to maternal mortality, the goal is to reduce the maternal mortality ratio to less than 70 per 100,000 live births.

Low-income countries have higher percentages of maternal mortality if compared with higher income and developed countries where the maternal mortality rate is 12 per 100,000 live births. Sub- Saharan African countries are known for having the highest maternal mortality rate all around the world with 546 maternal deaths per 100,000 live births, such as Nigeria, the Democratic Republic of Congo, Ethiopia, Uganda, Tanzania and Kenya and more.

Many reasons in Africa and its sub-saharan countries lead to the occurrence of this high percentage of maternal mortality rates and considered to be barriers against improving the situation, starting with the geographical factor, distribution of these countries villages and abandoned areas and the poor access to medical centers, because of long drives and distances, which is also connected to the lack of fast transportation, vehicles, and ambulances Moving to the lack of medical and health care centers especially in abandoned and far areas, this factor is very important in saving lives and making urgent intervention when needed, thousands of hundreds of African sub-Saharan population don’t get the needed and essential medical treatment, which makes it hard to survive urgent and acute cases, this makes it hard to seek medical care for women facing danger during pregnancy and delivery, as well as the lack of medical reporting and diagnosis. It’s also very important to mention the young age and under age marriages that take place in sub-Saharan areas which may be a risk factor for maternal mortality high prevalence as well as rape cases that may cause this. The incidences of diseases and outbreaks also play a role in maternal mortality high rates, uncontrolled transmitted diseases HIV/AIDs for example is considered one of the major risk factors for maternal mortality. Hygiene, sanitary products and access to clean water are also very important, lack of these elements cause infections, spread diseases, and even may lead to exceeding the cases and causing more severe complications. Malnutrition and the essential elements of deficiencies are also enrolled in this. Moving to culture, beliefs, and traditions, in many sub-Saharan areas in Africa, morals, tradition, and inherited manners can lead to exceeding maternal mortality incidence, various beliefs and ways of dealing with women in general and young pregnant women especially. Women's level of awareness and understanding of their health status, way of living, circumstances, background, and hereditary is vital, and can cause deterioration in their health status during pregnancy, and during the delivery process. Another cause is poverty, and socioeconomic situation, which put many borders against women to seek appropriate medical treatment and consultation and limits them from purchasing the needed equipment and medications.

Maternal mortality rates affect the demographic construction of the areas and countries in Sub-Saharan Africa, it also culturally affects the children’s lives, and their psychological development as well as the cultural diversity in general. The high rates of reasons and consequences lead to an economic burden concerning treatment, examinations, tests and intervention procedures, as well as the expenses needed for neonatal and unhealthy newborns treatments and curing post-delivery complications.

These mentioned numbers, rates, and causes led to raising maternal mortality issue worldwide and made it one of the most important issues to be listed among the MDGs and afterward on the SDGs. due to its existence for decades, and despite the healthcare development, specialties and equipment, it stays on the top of the SDGs due to its importance and wide range of effects. Despite the fact that the maternal mortality ratio has dropped off during the last two decades, it still needs short and long term strategies and intervention plans, many initiatives and studies aimed to examine interventional procedures, and test the possibility for leading to improvement in this context, although many interested parties intervene and some of them succeed in many areas, the incidence is still the highest around the world and the small initiatives need to be implemented widely so the total ratio may fall down more and more one of these studies is the ‘Rapid reduction of maternal mortality in Uganda and Zambia through the saving mothers, giving life initiative: results of year 1 evaluation’ by Serbanescu F. et al (2017), the research adopted a Saving Mothers Giving Life (SMGL) initiative which aimed to quick reduction of maternal mortality rate, in one year interventions strategies, using possible and applicable ways, to be applied and measured in Both Uganda and Zambia, there were differences in applying the SMGL in both countries according to the specifications in each one of them, such as the number of hospitals and medical care centers, quality of care, equipment, and more. The initiative implemented a number of interventions such as training health teams to deal with birth cases, raising awareness and promotion concerning pregnancy and delivery, raising the number of healthcare facilities especially in abandoned areas, and much more. This one year SMGL proved to reduce the Maternal mortality rate in Uganda by 30% from 452 to 316 per 100,000 and by 35% in health facilities in both countries.

An additional study that aimed to test MMR reduction is ‘Social factors determining maternal and neonatal mortality in South Africa: A qualitative study’ by Mmusi-phetoe RM, which included interviews with ten pregnant women in public hospitals, the study aimed to outline the main social reasons that lead to high MMRs in south Africa. Through this study poverty was addressed as a major cause for MMRs.

These studies and other studies proved that MMR reduction is possible and maybe achievable despite all the obstacles. But with a wider range and more influential and larger spectrum of interventions that suit different areas’ specifications and needs. Thus, working on training medical teams and health care staff members is crucial, and empowering additional staff and trainees, and volunteers to be capable to take care of pregnant women and through delivery process. Work on building health care points and remote points in abandoned and neglected areas which may facilitate seeking health care. Building a database and documentation for pregnancies and delivery cases complications, diagnosis and family history in multiple health facilities such as public facilities, in order to have information and data concerning this issue, so analysis and statistics recording maybe possible, this will lead to having a wider image about MMRs and opens the opportunity for researchers to have more access to helpful data for further development. Supplying health care centers with the needed equipment to deal with urgent and complicated deliveries as well as developing departments for obstetric care and neonatal care. Applying screenings, tests and examination through the pregnancy process, in order to identify risk factors, problems and possible complications that may occur during pregnancy and delivery. Raising awareness, teaching women and family members about the importance of screenings, tests, examinations and seeking periodic medical care, before and during pregnancy, and ask for further healthcare after delivery especially cases with complications for the mother and the child, by applying presentations, workshops, and experts visits to communities, in order to teach about this topic, and raise awareness concerning its effects socially, financially and medically on the short and long terms. Raising awareness concerning young age marriages and pregnancies, and the preparedness of the girls bodies to pass pregnancy periods and giving birth, such as opening enough space of time between delivery and the following one, testing HIV/Aids, and other illnesses and transmitted diseases and explain their effects on having babies, and the complications they may cause to mothers during pregnancy, delivery and afterwards. Recommendations and interventions are needed in all layers starting with the individual locals in the Sub-Saharan countries, moving to the community and community centers, health care facilities, hospitals, reaching influential organization, people in charge, decision and policy makers in a wide range, that may lead to seeking foreign expertise and experience, and fundraising in order to be able to purchase and have access to all needed supplements and equipment, reducing MMRs to the lowest rate possible is a national task lead by the country authorities and government and all parties that can have influence in it due to its importance in saving hundreds of women’s lives, and setting MMRs decrease and improving the quality of women’s lives as part of family health, starting from the Sustainable Development goals for 2030 set worldwide and especially in African countries.

As seen above, the importance of developing and increasing women’s quality of life is rising every day, it’s vital that further studies and research to be applied widely, all over the world, further data and information are also needed in order to move forward towards this SDG,