No Silver Bullet: Maternal Mortality in Palestine

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.

–Elizabeth Arend

7 comments

  1. thank you for your interest and this easy-to-understand article. I learned some new stuff “postpartum” effect on mothers.

    regards from Gaza

  2. jehad · · Reply

    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,
    the other factors that mentioned in the study is traditional factors , its not so important it reflects the international opinion towards developing countries so its not true all the time

  3. @Jedad: Thank you for your comment. To clarify, the report that emphasized the role of “traditional factors” that contribute to maternal mortality was written by the Palestinian Ministry of Health–specifically, the National Committee on Maternal Mortality. (UNFPA only provided financial and technical support).

    I agree with your argument that the occupation has a great impact on Palestinian women’s maternal health. The MOH, however, argues that there are other important factors at play. What can the MOH do to address these traditional factors that affect maternal health?

  4. Kim Nguyen · · Reply

    The assessment of maternal danger for women in West Bank and Gaza is frightening. Among the causes listed, the occupations roadblocks to maternal care are getting worse rather than improving.
    I do have a question about the figures in second paragraph. One maternal death in 430 ? That would be 232+ per 100,000, not 46 per 100,000. Which is it? Only live births are considered in the second figure? How high is the infant mortality rate in Palestine?
    One other question: What is the effect on maternal health and infant deaths of the lack of good water?

  5. @Kim Nguyen: Thank you for your comment! To clarify, maternal mortality rate (MMR) is always calculated with a denominator of 100,000 live births. The WHO 2008 MMR estimate for the West Bank is 46 maternal deaths/100,000 live births. If you look closer at district-level data, you will find MMR as low as 13 deaths/100,000 live births in Jenin, and as high as 68 deaths/100,000 live births in Jericho.

    When I mentioned the data on a Palestinian woman’s risk of maternal death, I should have clarified that this risk is lifetime risk–in other words, the cumulative risk that a woman faces throughout her reproductive years of dying in pregnancy and childbirth. I found 2007 UNICEF data that actually puts Palestinian women’s lifetime risk of maternal death at 1 in 140. (Source: http://archive.k4health.org/system/files/West_Bank_Gaza.pdf)

    According to CIA data, Gaza’s infant mortality rate is 16.55 infant deaths/1,000 live births; the West Bank’s IMR is 14.47/1,000 live births. (This compares to 4.07/1,000 live births in Israel). (Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html)

    The lack of clean water and other environmental hazards certainly contribute to poor maternal and infant health, but there are many more significant contributing factors to infant mortality. A recent WHO study among Palestinian refugees found that the following conditions contributed the most to infant mortality:

    1) conditions related to low birth weight or prematurity
    2) congenital malformations
    3) respiratory infections
    4) birth trauma

    (Source: http://www.who.int/bulletin/volumes/89/4/10-082743/en/index.html)

    I hope this answers your questions! I will definitely explore the infant mortality issue in more depth in a future blog post.

  6. Kim Nguyen · · Reply

    Thank you so much for this (quick!) response. It clarifies the report and gives so much more information – thank you!

  7. [...] a previous ACP blog post explained, Palestinian women face a relatively high rate of maternal mortality in the West Bank [...]

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