Poor correlation between coverage of ‘essential interventions’ and maternal mortality

I was browsing the WHO section on maternal and perinatal health over my morning coffee this morning (just like everyone else does, I’m sure). I stumbled across an article titled “Need to go beyond “essential interventions” for reducing maternal mortality”.

The article states “A large WHO multicountry survey examined data from more than 300 000 women attending 357 health care facilities in 29 countries. This study found a poor correlation between coverage of ‘essential interventions’ (e.g. uterotonics for preventing postpartum haemorrhage; magnesium sulfate for eclampsia) and maternal mortality in health facilities.”.

The WHO goes on to say they interpret this as meaning “universal coverage of life-saving interventions need to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care.” You can read about the study here.

I wonder if we should be interpreting it to mean that they might be looking in the wrong direction. Maybe improving access to interventions and emergency medical care isn’t where the priority should be if it doesn’t seem to be working. Is it possible that interpreting the finding that medicine isn’t working as meaning we just need MORE medicine might be flawed? Maybe we should be focusing on what we KNOW improves outcomes: social support of the mother and nutritional status of the mother.

I don’t want to imply that medical and emergency care isn’t ever useful, but I sure wonder what would happen if we spent as much energy and money on improving nutritional status and social support for women as we did on medical care.

A few readings on social support and nutrition and how it influences health outcomes for mother and baby:

• Maternal Social Support Predicts Birth Weight and Fetal Growth (Feldman et al, 2000)
• Pregnancy Nutrition and Later Health Outcomes
• Maternal Nutrition Status Dictates Neonatal Health Outcomes

Isn’t there a saying by one of those famous science dudes about doing the same thing and expecting different results? Is it appropriate to reflect on good ol’ Einstein here?

Food for thought, I would say. Comments welcome below.

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