Just as many women are dying in pregnancy and childbirth in the UK as they were 20 years ago, leaving Britain trailing behind countries like Albania, Poland and Slovakia as well as the wealthier nations of Europe.
The stagnation of the UK, only 23rd in the global league table, contrasts strikingly with the developing world where, according to a major new and comprehensive study, real inroads are being made on death rates among women in childbirth.
Globally, the number of deaths dropped from more than 500,000 a year in 1980 to 343,000 a year in 2008. In the last 20 years, deaths have been declining at a rate of about 1.4% a year.
"These findings are very encouraging and quite surprising," said Dr Christopher Murray, director of the influential Institute for Health Metrics and Evaluation in the USA and one of the authors of the report published online by the Lancet medical journal. "There are still too many mothers dying worldwide, but now we have a greater reason for optimism than has generally been perceived."
But while death rates appear to be coming down in a way nobody expected in the developing world, in the UK they have flat-lined. The reasons include a rise in the numbers of women having their babies later in life and an increase in those who are obese, increasing the risk of complications in pregnancy.
While Cathy Warwick, general secretary of the Royal College of Midwives, welcomed the global death rate drop, she said: "I am concerned that the UK rate – although it is very low – is not falling. It is possible that this is due to increasing levels of ill-health amongst pregnant women and possibly to greater numbers of older women giving birth."
Dr Maggie Blott, consultant obstetrician and spokeswoman for the Royal College of Obstetrician and Gynaecologists, pointed out that the death rate in the UK was very low and that it is "an incredibly safe place to have a baby". But, she said, the reason the death rate has not come down may be to do with changing demographics.
"What has changed is the reason for women dying in the last 20 years," she said. Deaths from the basic problems of childbirth, such as pre-eclampsia (a complication of high blood pressure) had come down, but deaths from heart disease are going up.
The reasons are an older and more obese population. "We know older women are over-represented in the maternal death statistics and the average age of childbirth is going up," she said. Pregnancy and childbirth cause huge physiological stress, which younger women cope with better than older women.
"Women who are older are more likely to have high blood pressure and more likely to have heart disease. We now see women having heart attacks during pregnancy, which was unheard of in the past." The increasing rate of caesarean section was also cause for concern – women who have had a number of C-sections are more likely to haemorrhage in a later pregnancy.
Louise Silverton, deputy general secretary of the Royal College of Midwives, said that health inequalities were a factor. Among some ethnic minorities – particularly those who are recent arrivals in the UK – women may not understand the system and may not go to the GP for antenatal checks...
The safest country in the world in which to give birth appears to be Italy, with a death rate of 3.9 women for every 100,000 births – down from 7.4 in 1990. Next come Sweden, Luxembourg and Australia. All have brought their death rates down by more than 1% over the same period. Israel, in 8th place and Malta, in 9th, have brought their death rates down by 3.2% and 4.7% respectively. But the UK had 8.4 deaths per 100,000 births in 1990 and 8.2 deaths in 2008, a drop of just 0.1%.
The most recent comprehensive investigation into the deaths of women in pregnancy and childbirth in the UK was published at the end of 2007. CEMACE (the confidential enquiry into maternal and child health) looked into the deaths of 295 women between 2003 and 2005.
"Many possible factors lie behind the lack of decline in the maternal mortality rate," said the report. "They include rising numbers of older or obese mothers, women whose lifestyles put them at risk of poorer health and a growing proportion of women with medically complex pregnancies.
"Because of the rising numbers of births to women born outside the UK, the rate may also be influenced by the increasing number of deaths of migrant women. These mothers often have more complicated pregnancies, more serious underlying medical conditions or may be in poorer general health. They can also experience difficulties in accessing maternity care."
Source: Sarah Boseley, The Guardian, 13 April 2010 or http://www.ippf.org/
No comments:
Post a Comment