Sustained progress in maternal health care, but deficient access, inequities in poorest countries pull down averages

Yet, countries such as Yemen and Sudan hold maternal mortality ratios which more than double the regional average of 210. While this figure is tripled in Djibouti, it reaches colossal proportions in South Sudan, where maternal mortality is almost eight times higher and the one of the worlds' indisputably highest, with the current ratio at 2,037 per 100,000 live births.

A glance at country-specific scenarios in the region reveals the following:

- Countries like Egypt and Morocco have demonstrated drastic, steadfast progress towards achieving skilled attendance at delivery since 1995. Still, there remain 37% and 26% of births in those countries respectively, which are taking place in the absence of midwives and/or adequately trained health practitioners.

- Barely forty per cent of women in Yemen receive antenatal care during pregnancy and only 27% of births are attended by skilled health personnel.

- More than a decade of internal conflict and political rift with the North has left South Sudan with almost inexistent emergency obstetric care, radically low levels of contraception and skilled birth attendance at hardly five per cent, coupled with high rates of early marriage and teenage pregnancy.

- Even though maternal health care in Iraq has been gravely weakened by armed conflict, an estimated 89 per cent of births are assisted by trained staff. Concerns remain, however, about the rising number of women delivering at home and without the assistance of trained birth attendants, which results from the persisting breakdown in insecurity nationwide and the acute shortage of medical and health staff, with steady numbers of professionals fleeing the country.

- Despite years of blockade, the occupied Palestinian territory today sustains skilled personnel attendance rates at 99%.

- Syria has showed remarkable improvement with 93% skilled attended at delivery since 2006.

- Skilled health attendance at birth fluctuates between 98-99% in the GCC but Jordan remains so far the only country in the region with coverage of 100%.

The Middle East and North Africa currently contribute 4% (that is 21,000) of all maternal deaths related to pregnancy and immediate post-partum difficulties globally (515,000). The lifetime risk of maternal death is 1 in 140 in the region; a figure almost ten times higher than that in industrialized countries on average.

Pervading disparities and vast contrasts in access:

Lifetime risk of maternal deaths is 1 in 19 in Yemen and Djibouti but 1 in 6000 in Kuwait, and 1 in 1200 in Bahrain, which illustrates the magnitude of country-by-country disparities in the region.

Women in the region still suffer from disease and chronic health problems stemming from poor nutrition and inadequate health care provision. High maternal mortality levels are closely tied to the quality of antenatal care, the absence of timely referral systems and effective emergency obstetric care as well as access to family planning. Marked social and economic inequities also persist between and within countries in the region with regards to access to and quality of health services, especially in the area of reproductive health.

This has a particular effect on rural populations, as accessibility is not only determined by geographic distance but it is closely linked to varying qualifications of health staff from one province to another, on the one hand, and women's levels of literacy, household knowledge of risk signs ahead of and during pregnancy; as well as their social and economic status, on the other.

Alongside rapidly declining trends in infant and child mortality, the region has witnessed similarly fast reduction of the fertility rates, especially in some of the region's largest countries (Egypt, Algeria and Iran). The region's fertility rate declined from nearly seven children per woman in the seventies to three children in 2006.

Contraception, still widely misunderstood:

While contraception prevalence in the region is slightly above South Asia and all of Africa at 55%, legal, religious, cultural and social factors continue to hinder women's access to adequate family planning interventions (i.e. quality health care during pregnancy and post-partum, emergency obstetric care and birth spacing) which would greatly reduce a woman's lifetime risk of maternal death.

"Ensuring enhanced and unrestricted access to maternal health care, reproductive health knowledge and services will not only spell the difference between life and death for millions of women across the region, but it will visibly boost the achievement of virtually every MDG,"

said today Dr. Haydar Nasser, UNICEF's Child Survival and Development Specialist for the Middle East and North Africa.