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Pregnant woman

An international group of maternal and child population health experts are calling on governments to invest in better obstetric surveillance systems, break down barriers in data sharing, and eradicate a culture of blame to help address stagnating maternal mortality rates globally.

The International Network of Obstetric Survey Systems (INOSS), involving researchers from Oxford Population Health’s National Perinatal Epidemiology Unit (NPEU), outlined these calls to action in a commentary piece published today in The Lancet.

The commentary responds to recent UN data which show that improvements in maternal mortality rates have stalled in 133 countries and are getting worse in 17 countries, particularly in Latin America, the Caribbean, Europe, North America, and sub-Saharan Africa. Women in low- and middle-income countries continue to suffer the greatest burden whilst marginalised groups in high-income countries, such as the United States, are at a disproportionately increased risk.

The commentary calls for three specific actions from governments worldwide:

  1. Investment in the establishment and maintenance of effective and robust enhanced obstetric surveillance systems (EOSS).

The World Health Organization encourages countries to use systems such as the Maternal and Perinatal Death Surveillance and Response (MPDSR) programme, which can be complemented by enhanced obstetric survey systems (EOSS), to monitor mortality data at the regional and national level. However, the authors point out that some low-income countries continue to rely on less accurate census data due to the cost of implementing these systems whilst high-income countries do not prioritise timely and good quality perinatal data. Therefore, more investment is needed to address these issues. As the commentary states, ‘In this era of big data insufficient investment in knowledge about women and babies who die or nearly die, is unacceptable.’ 

  1. Introduction of health-care policies to facilitate and encourage data gathering, linkage, and transfer within existing or newly created legal frameworks.

International collaboration is crucial in reducing global maternal morbidity. However, the authors note that strict interpretations of regulatory mechanisms such as the General Data Protection Regulation (GDPR) make it particularly difficult for data sharing to happen even when a breach of privacy and confidentiality is unlikely. Newly created legal frameworks could overcome these issues, enabling health professionals to act rapidly in response to emerging health trends, including maternal outcomes. 

  1. Implementation of confidential, health-sector-controlled, case-based analyses of maternity care that emphasise learning lessons rather than assigning blame.

The authors also highlight that a culture of blame and poor leadership in healthcare settings is leading to many maternal deaths going unreported due to fear of litigation and disciplinary procedures. A rethink of a top-down government-led approach and review of reporting mechanisms for maternal deaths is needed to protect healthcare professionals. 

Professor Marian Knight, Director of NPEU and co-author of the editorial said ‘The UN’s 2030 agenda and Sustainable Development Goals are intended to reduce maternal deaths to under 70 per 100,000 livebirths globally, but we are unlikely to meet these targets without immediate action.’

Co-author, Professor Manisha Nair, added ‘The lack of progress on maternal mortality highlighted by the UN data is unacceptable. Governments need to remove the barriers for researchers and clinicians striving to ensure healthy pregnancies for all, and healthcare professionals must learn from the most severe outcomes.’

INOSS was established in 2010 to improve the care given to women, their babies and their families through international cooperation and collaborative working. It connects countries with the same or similar surveillance systems to facilitate studies of uncommon and severe complications of pregnancy and childbirth and provide high-quality evidence to guide clinical practice.