Caesarean sections have been lifesaving procedures for hundreds of thousands of women across the world who experience complications during labour.
Globally, it’s estimated that just under 20% of births take place via caesarean section – a percentage that’s gone up over the last three decades. This has raised concerns, particularly in high-income countries where generally too many caesarean sections are performed.
But in many African countries women who are medically required to have caesarean sections are not able to access them. This is due to several reasons, the most prominent being weak health systems and a lack of resources.
This needs to be fixed as women in sub-Saharan African suffer from the highest maternal mortality ratio in the world. Close to 550 women die for every 100 000 children that are born. This amounts to 200 000 maternal deaths a year – or two-thirds of all maternal deaths per year worldwide.
The more technology improves in low-and-middle income countries the quicker mobile apps will be invented and scaled to better people’s live. We already know that banking apps have transformed the exchange of money and have helped economies like Kenya’s thrive. Now, innovators are looking to create more and more mobile apps to transform health care and save more lives.
Sub-Saharan Africa has some of the highest maternal mortality rates in the world. While those numbers have fallen considerably over the past decade, the numbers still remain incredibly high. In Tanzania, for example, the maternal mortality rate is 578 per every 100,000 live births according to the World Health Organization. Most of these deaths occur due to postpartum hemorrhage, complications during delivery and postpartum infections. When women deliver their babies at home or do not get proper prenatal care during pregnancy the probability that they might die increases.
The JamboMama! app provides health information to expecting women and connects them to their health workers. It provides pregnancy updates and sends women’s medical records to the hospital where they will give birth. JamboMama! also sends text updates about the mother’s pregnancy and prompts her to answer questions about how she is feeling and how her pregnancy is moving along. For women in rural communities who cannot always get to their community health posts, health clinics, or hospitals JamboMama! can be the difference between life and death.
During my visit to Haiti two years ago I had the privilege of visiting two hospitals: L’Hôpital Albert Schweitzer (HAS) in Haiti’s Artibonite Valley and L’Hôpital Sainte-Thérèse in Hinche, Haiti. Many of the patients at both hospitals, I learned, walked or took public transport over long distances for quality hospital care. As the poorest country in the Western Hemisphere, Haitians need many more hospitals and health workers to care after their sick. There are currently only six health workers for every 10,000 Haitians according to USAID. And, Haiti has the highest rate of infant, child, and maternal mortality in the Western Hemisphere. Most Haitians live on less than $1 a day and their life expectancy is only 64 compared to 74 for its neighbor, the Dominican Republic.
Quality health care in Haiti continues to be one of the country’s greatest problems. In fact, Haiti only spends 6 percent of its expenditures on health care and relies heavily on international funding.
After eight years of practicing obstetrics and researching childbirth in the United States, I know as well as anyone that the American maternal health system could be better. Our way of childbirth is the costliest in the world. Our health outcomes, from mortality rates to birth weights, are far, far from the best.
The reasons we fall short are not obvious. In medicine, providing more care is often mistaken for providing better care. In childbirth the relationship between more and better is complicated. Texan obstetricians, when compared to their counterparts in neighboring New Mexico, are 50% more likely to intervene on the baby’s behalf by performing a cesarean section. Nonetheless, Texas babies still have a lower survival rate than New Mexican babies.
I long assumed that our most puzzling American health care failures were idiosyncrasies–unique consequences of American culture, geography, and politics. But a trip to India for the 2017 Human Rights in Childbirth meeting led me to a humbling realization: when it comes to childbirth, both countries fall short in surprisingly similar ways.
Human rights in childbirth
I take care of patients in at a well-funded teaching hospital in Boston, where pregnant women seem well-respected and have clear, inviolable rights.