On International Women's Day: A new report monitors Egypt's success in reducing maternal mortality
On International Women's Day, the Egyptian Initiative for Personal Rights (EIPR) salutes the accumulated efforts that led to a decrease in maternal mortality rates in Egypt in the twenty-year period between 2000 and 2020, as stated in a recent report by the United Nations Maternal Mortality Estimation Inter-agency Group (MMEIG), which covers trends in maternal mortality over the past two decades. The report reveals that Egypt is among ten countries that witnessed the largest decline in maternal mortality rate during that period. While maternal mortality rate in Egypt was 79 deaths per 100,000 live births in 2000, it decreased to 17 in 2020, according to the UN report. EIPR also calls for mainstreaming all indicators of sexual and reproductive health and rights of women and girls in all public policy design, and making available detailed data that allow the design and evaluation of interventions aimed at ensuring those rights for all women and girls in Egypt.
The report released by the group - which includes the World Health Organization, the United Nations Children's Fund (UNICEF) and the United Nations Population Fund among others - provides comparable global, regional, and country estimates of maternal mortality over 20 years. The World Health Organization defines maternal mortality as “the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy..”
The report’s data on Egypt is largely positive. In addition to the fact that Egypt is one of the countries that achieved the most progress on this important indicator, this improvement exceeds the target set by the National Strategy for the Empowerment of Egyptian Women that the rate would be 26 out of every 100,000 live births by 2030, although the estimates in the strategy and the report regarding the rates for the years 2014 and 2015 are significantly different from each other. While the report specified that the maternal mortality rate in 2015 was 24, the strategy’s estimate was 52 deaths out of every 100,000 live births; This raises questions about the accuracy of the indicators of the national strategy, which relied on unspecified data from the Central Agency for Public Mobilization and Statistics (CAPMAS).
Despite this positive development, by examining the indicators of the UN report, it becomes clear that most of this improvement occurred in the period between 2000 and 2010, where that period witnessed a decline in the rate to 41 deaths per 100,000 live births, while the rate declined in the period between 2010 and 2020 with only 21 annual deaths. The report provides only averages at the national level, which does not allow data segregation according to geographical distribution and income. This calls for the state's publication of segregated detailed data, especially since the results of the latest Egypt Demographic Health Survey (EDHS) issued in 2014, which is the last health survey whose data was fully released, shows a clear disparity in antenatal health care services provided between the richest and poorest social classes and between the central provinces and the poorer and peripheral provinces, in favor of the richer classes and the richer provinces. More details can be found in EIPR’s report "Social Justice and Health in Egypt" issued in 2018, which used the data of the 2014 Population Health Survey.
In presenting its efforts to improve maternal mortality rates in Egypt, the United Nations Population Fund (UNFPA) identified the challenges facing reducing maternal mortality as follows: low contraceptive prevalence, teenage pregnancy, unmet need for family planning, as well as childbirth in unlicensed settings such as private clinics. Some of these challenges are in and of themselves sustainable development goals as well. It is noteworthy that several scientific literatures indicate that most maternal deaths and neonatal problems in Egypt can be prevented in advance if women receive basic and continuous health care services before, during and after childbirth. However, the use of continuous maternal health care services is still significantly low among Egyptian mothers, especially in rural areas. Added to this is the problem of insufficient knowledge among service providers of health care skills ante- and postnatally, as empowering health service providers to be more knowledgeable and skilled, while increasing women's awareness in general and adolescent girls in particular of their reproductive rights, are crucial to reducing maternal mortality by facilitating awareness-raising activities, increasing access to medical services and places where health services are provided, and providing first aid measures to manage complications.
The preliminary indicators of the Egyptian Family Health Survey announced in August 2022 shed light on some patterns that are supposed to have contributed to the improvement of the maternal mortality index, such as the improvement in some indicators of women’s access to pregnancy care in general, or on a regular basis, and the increase in births attended by medical service providers. However, the survey also highlights some worrying indicators related to this last indicator. An increase in the rate of deliveries by medical service providers was associated with an even greater increase in the number of cesarean sections, as preliminary survey indicators show that three out of four women in Egypt gave birth to their last child by cesarean section. The survey also indicates that one out of every five children born in Egypt in the five years preceding the survey was the result of an unwanted pregnancy, which is consistent with another reported indicator of an increase in unmet needs for contraceptive methods for women in Egypt compared to the previous survey in 2014.
EIPR reiterates the importance of urgently making publicly available the demographic health surveys data, foremost the 2022 Egyptian Family Health Survey, to learn the reality of health indicators in Egypt, including patterns according to income and geographical distribution in relation to changing rates such as maternal mortality.
It is noteworthy that over the past fifteen years, maternal and neonatal mortality rates have decreased in most parts of the world, although not to the extent that was expected when the Millennium Development Goals were adopted in 2000. The UN report noted that “between 2000 and 2020, 69 countries reduced maternal mortality rates by at least half; and in 34 countries maternal mortality rates were reduced by two-thirds.” In view of the critical importance of reducing maternal mortality rates, the Sustainable Development Goals have designated a special indicator therefore and set it globally to reduce the maternal mortality rate to less than 70 deaths per 100,000 live births by 2030.