Bangkok—With all the talk about the impending “Asian century,” one might imagine that the region had moved beyond what are often viewed as poor-country health challenges, like high rates of maternal mortality. The reality is very different.
In 2015, an estimated 85,000 women died of complications related to pregnancy and childbirth in the Asia-Pacific—28 percent of the global total. Up to 90 percent of those deaths, which were concentrated in just 12 countries, could have been prevented through quality antenatal, obstetric and perinatal care.
In the absence of such care, the average maternal mortality rate (MMR) in the Asia-Pacific is extremely high: 127 per 100,000 live births, compared to the developed-country average of 12 per 100,000. The 12 countries with the highest MMRs, exceeding 100 deaths per 10,000 live births, are Afghanistan, Bangladesh, Cambodia, India, Indonesia, Laos, Myanmar, Nepal, Pakistan, Papua New Guinea, the Philippines, and Timor-Leste.
These countries together accounted for about 78,000 known maternal deaths in 2015. The actual figure is probably higher. In fact, MMRs are notoriously difficult to estimate, with conflict, poverty, poor infrastructure, weak health systems, and inadequate resources causing many deaths to go unreported.
Still, MMR data indicate general trends, which are not promising. If they persist, hundreds of thousands of mothers in those 12 high-MMR countries alone could lose their lives by 2030.
To be sure, substantial progress has been made in the last 15 years, and efforts are being made to sustain it. The United Nations development agenda, underpinned by the Sustainable Development Goals (SDGs), aims to reduce the MMR to 70 deaths per 100,000 live births by 2030. If that target is met, up to 100,000 lives could be saved in the Asia-Pacific.
Achieving the goal presupposed faster progress, with annual rates of MMR reduction particularly low (2 percent) in Papua New Guinea and the Philippines. At a time when family planning policies are becoming increasingly restrictive, accelerating the pace of progress could prove difficult. Indeed, for some countries, progress is at risk of slowing.
The UN Population Fund (UNFPA) is working hard to counter this trend. We are committed to ensuring that all pregnancies are safe and wanted, and that all women and girls are empowered not just to make their own choices about their own families and bodies, but also to contribute more to poverty reduction and economic development.
In the 12 high-MMR countries, the UNFPA advocates the development of responsive and inclusive health systems with sufficient numbers of trained personnel, from midwives to community-health workers. And we are working to advance that objective.
But more investment must be channeled toward ensuring that comprehensive health services are available and accessible to all. Additional resources must be allocated to sexual- and reproductive-health services—and to ensuring access to them.
Women also need access to family planning services, to help them avoid unwanted pregnancies and reduce the number of unsafe abortions. The rights of all women and their partners to choose the family planning method appropriate for them must be respected, and a full range of quality contraceptives must be readily available to all.
When women have full control over their sexual and reproductive health, society as a whole reaps enormous benefits. In fact, every $1 invested in modern contraceptive services can yield as much as $120 in social, economic and environmental returns. The investment should come partly from international development assistance, which must place a higher priority on sexual- and reproductive-health services, and partly from national governments.
But governments can and must develop inclusive policies that address the needs of vulnerable and marginalized groups, in ways that go beyond the health sector. This includes fighting harmful practices such as child marriage and gender-based violence; removing legal barriers to contraception; and working with communities to address misconceptions around sexual and reproductive health. Project Syndicate
Anderson Stanciole is a health economics advisor and Federica Maurizio is a health economics and SRHR Fellow at the UNFPA’s Asia-Pacific Regional Office.