Preventing Maternal Mortality

Resources Topic 4: Evidence-based Solutions outside the health service

Core resources

It is in this topic that we really can appreciate how interwoven the SDG’s actually are. While the reduction of maternal mortality falls under SDG3 (most directly related to health), there are a multitude of factors outside the health system affect women’s vulnerability during pregnancy and childbirth, changing the chances of having an unwanted pregnancy or childbirth, of suffering complications during pregnancy and childbirth, and of being able to receive appropriate and timely care in case of such complications.

It is estimated that up to 50% of the gains in the health of women, adolescents and children may results from investments outside the health sector. This number is included in page 62 of The Global Strategy for Women’s, Children’s and
 Adolescents’ Health (2016-2030) to which we referred in Topic 3 (see excerpts here). Many (if not all) other SDGs are thus important for the reduction of maternal mortality, notably SDG1 (poverty), SDG54 (education), and SDG5 (gender equality).

Returning to Figure 1 on page 17 of the strategy provides a good overview of areas for intervention outside the health care system to contribute to reduced maternal mortality:

• Finance and social protection
• Education
• Gender, preventing child marriage
• Civil registration, law and justice
• Water and sanitation, nutrition, agriculture
• Environment and energy
• Labour and trade
• Public infrastructures, including facilities and roads
• transport
• Information and communication technologies

Annex 4 on pages 95-96 of the strategy provides examples and more details on the options for interventions in these areas. However, unlike the recommended interventions in health care and the health care sector, here it is much less clear on what interventions exactly are effective in improving the identified problems in the various sectors, and in which context. There are no obvious policy documents with clear-cut recipes for universally effective solutions here.

Research in this area is largely outside the traditional field of public health, and includes many disciplines, such as agriculture, law, economy, psychology, sociology, anthropology, etc. Multidisciplinary approaches are key to move forward on building evidence-based solutions.While these solutions outside the health sector may be viewed through the lens of social determinants of health, we can also come back to the human righst approach: The United Nations Human Rights Office of the High Commissioner, in Women’s Human Rights and Gender Equality, reminds us that "Gender equality is at the very heart of human rights and United Nations values. A fundamental principle of the United Nations Charter adopted by world leaders in 1945 is "equal rights of men and women", and protecting and promoting women's human rights is the responsibility of all States." “However,  important gaps remain and women’s realities are constantly changing, with new manifestations of discrimination against women regularly emerging. Intersecting forms of discrimination, combining factors such as sex, age, ethnicity, nationality, religion, health status, marital status, education, disability and socio-economic status, among other grounds, also have a particular impact on women, which must be factored into responses.”

Three key areas in this context are limited female education, gender inequality, and poverty.

The 'Leave No Girl Behind' - a new wave of activism for female education http://www.ungei.org/index.php the UN girls education initiative have just launched the Leave No Girl Behind Campaign, which will shortly develop policy papers aiming at speeding up progress in female education (as stated on their website):

Established in 2018, the Platform for Girls’ Education is one dimension of the Leave No Girl Behind Campaign — a group of 12 influential figures with a shared commitment to ensuring all girls complete 12 years of quality education. In partnership with the REAL Centre at the University of Cambridge and the United Nations Girls’ Education Initiative (UNGEI), the Platform is developing a series of policy papers that provide insights into how we, as a global community, can work together to break down barriers to girls’ education."

The summary report of 12 Years of Quality Education for All Girls: A Commonwealth Perspective offers a number of practical evidence based solutions to improving girls' education in three main areas:

A. Leadership and financing
1. Visible high-level political commitment backed up with resources.
2. Grassroots leadership increasing awareness about the value of girls’ education.
3. Formula funding targeting resources at those most at risk of being left behind.
4. Use of data to inform policy change.
B. Targeted approaches
5. Prioritising early childhood education and early learning.
6. Addressing multifaceted challenges that girls face when they reach puberty.
7. Eliminating cost barriers.
8. Tackling disadvantages that intersect with gender, such as disability, location, poverty.
C. Tackling discrimination
9. School environments that are safe spaces.
10. Gender-sensitive teaching practices and materials.
11. Promoting women’s economic empowerment and providing pathways to productive work.
12. Tackling access and learning simultaneously, with sufficient resources.

The global Multidimensional Poverty Index (MPI) is an international measure of acute multidimensional poverty covering over 100 developing countries. It includes measures of health, education and living standards.

The UN Women site provides a progress report on the SDGs to 2019 in The Gender Snapshot. The report shows "Why a multidimensional and multisectoral approach matters".

Some examples of relevant research

Below, you will find some examples of relevant research - they also highlight difficulties such as which indicators to use, how to measure them, and how to define success of interventions. 

You might want to choose from amongst these the articles of your interest. They are designed to awake  interest outside articles which are directly health-related:

• Can self-help group programs improve women’s empowerment? A systematic review

• Composite measures of women’s empowerment and their association with maternal mortality in low-income countries

• Women’s empowerment: what works?

• Evaluation of a male engagement intervention
to transform gender norms and improve family planning and HIV service uptake in Kabale, Uganda

• Interventions to Prevent Child Marriage Among Young People in Low- and Middle-Income Countries: A Systematic Review of the Published and Gray Literature

• A Time for Global Action: Addressing Girls’ Menstrual Hygiene Management Needs in Schools

• Cycling to School: Increasing Secondary School Enrollment for Girls in India

• Theory and practice of social norms interventions: eight common pitfalls

• The Communities Care programme: changing social norms to end violence against women and girls in conflict-affected communities

• Strategies and governance to reduce
health inequalities: evidences from a cross- European survey


• Women’s land rights as a pathway to poverty reduction: framework and review of available evidence