UNFPA’s new report, “Trends in Maternal Mortality: 1990-2010,” includes great news for women of reproductive age. Globally, the total number of deaths during pregnancy and childbirth decreased by 47% from 543, 000 in 1990 to 287, 000 in 2010.
Although the overall decline in maternal death is cause for celebration, the picture gets more complicated when you look a little closer at country-level data, especially when you look at Israel compared to the West Bank/Gaza Strip. Israel is classified as a “developed” country, where women face an average 1 in 3800 chance of dying during pregnancy and childbirth. This compares to the Western Asian region, including the West Bank and Gaza Strip, where women face a 1 in 430 risk of maternal death. This equates to 7 maternal deaths per 100,000 live births in Israel, compared to an average of 46 maternal deaths per 100,000 live births in the West Bank and Gaza Strip.
This is the kind of disparity that struck me when I first studied public health in Palestine in 2006. At the time, I wasn’t surprised by high rates of maternal death in Sub-Saharan Africa and Southeast Asia–I knew both regions were burdened by inadequate health care infrastructure, medical “brain drain,” and high rates of HIV. But why was there such a huge difference in maternal death between Israelis and Palestinians when they live side by side? Why does this disparity still exist today?
According to the World Health Organization, the majority of Palestine’s maternal deaths stem from women’s lack of access to adequate antenatal, childbirth and early postnatal health care. While lack of transport and long distances to maternal health facilities are common in developing countries, a UNFPA-funded report found that “the major obstacle [in Palestine] is political instability, military checkpoints and the construction of the Separation Wall, which can prevent mothers’ access to hospitals at any time.”
Restricted movement due to the Israeli occupation is certainly a critical factor, but the study also found an increased risk of maternal mortality due to:
- High rates of fertility among Palestinian women, which increase the lifetime risk of maternal death
- Early marriage/pregnancy among women of young maternal age (under 18) and many pregnancies among women of advanced maternal age (over 40)
- “Inadequate coordination between the multitude of service providers and the lack of unified protocols”
- “Low community awareness of danger signs during pregnancy, delivery and postpartum”
In partnership with Georgetown University Medical Center, ACP is trying to address maternal mortality and other critical health issues by developing the Ministry of Health’s institutional capacity and enhance clinical skills–including nursing and midwifery–among Palestinian physicians. We hope this initiative will address some of the factors that contribute to Palestine’s high maternal mortality rates, but of course, there is no silver bullet.
We invite your comments on the UNFPA study findings, and what you think should be done to address maternal mortality in Palestine.