October 28, 2016
Guest blog post by Jacqueline Bowman-Busato, Alliance for Maternal Health Equality.
Europe faces turbulent times. In his State of the Union address last month evoking an existential crisis in Europe, European Commission President Jean-Paul Juncker spoke of a sense of social injustice.
This is particularly pertinent when it comes to healthcare for women, before, during and after pregnancy. Inequity in terms of maternal healthcare is unfortunately a hallmark of health systems across Europe.
For many pregnant women, specific healthcare needs have not been acknowledged, let alone addressed. One woman in ten has no access to maternal healthcare in the first months of pregnancy, and in 2013 alone there were 1,900 maternal deaths in Europe. If we are to resolve this social injustice, we can no longer ignore the lack of access to timely and quality healthcare for women, before, during and after pregnancy, and the wider implications this has for the whole of society.
“Most of these deaths are completely preventable. So this is a problem that can be solved, but only if we work together across Europe to improve access to quality maternal healthcare and demonstrate to these women that we want to save their lives. Is that too much to ask?” says Ciara O’Rourke, MSD for Mothers Lead in Europe, Director Public Policy for Europe & Canada.
Indeed, the standard of maternal healthcare can be viewed as a litmus test of healthcare system performance within a country. Across Europe there is a need for indicators to measure this standard.
Despite the different situation in each country, the European Core Health Indicators seek to monitor and compare the situation across the EU and wider Europe. Yet, only four of these indicators actually focus directly on maternal health, namely: mothers’ age distribution, fertility rate, perinatal mortality and low birth rate. They need to be more encompassing, as maternal health is also dependent on broader factors such as social determinants and rural versus urban divide.
The Alliance for Maternal Health Equality held a workshop during the recent European Health Gastein Forum and during the Safe Motherhood Week, with the aim of introducing and validating for the first time a health systems performance measurement matrix focusing on several different aspects of maternal healthcare. The goal was to connect maternal health with the broader picture and relevant factors.
This was a rare opportunity for the various stakeholders to have an open discussion around this issue. Solutions proposed focused on a variety of practical measures and beliefs. For example, healthcare systems in Europe should follow a common set of quality and safety criteria for maternal care at the EU level, as opposed to the national level. Current global efforts to combat maternal morbidity and lack of healthcare access must also focus on Europe. Participants also acknowledged the perception of quality maternal healthcare as a privilege rather than a basic right.
Speaking at the Forum, Mervi Jokinen, President of the European Midwives Association, said addressing these deficits requires an integrated policy approach that places women at the centre: “For care to be relevant and accessible, women’s experience must be integral to the development of services. We need a more woman-centred approach to care.”
According to Ramazan Salman, Executive Director of Migrants for Migrants (MiMi), “women play a key role with regard to family health. They are experts in terms of their families’ health needs. Measuring health systems performance in regard to them therefore offers the opportunity to improve the health status of all Europeans.”
Finally it was agreed that national systems should strive to operate under common benchmark rules for maternal healthcare and as part of the country’s individual health system. In this case, the question is not so much about the level of competence, be it national or supranational, but about sharing best case practices and examples that can improve the situation for other countries as well.
The Alliance for Maternal Health Equality now aims to introduce and test the format at the national level and to create a bridge with the existing European-level efforts. Going national is necessary to delve deeper into the problem and the different national specificities involved, especially given the nature of health as a national competence in the EU. This will also improve the understanding of the problem of inequity and lack of access, via first-hand experience on the ground.
Europe must do better when it comes to maternal healthcare. In line with the United Nations Sustainable Development Goals, equitable access to maternal healthcare must be a top priority for Europe: a continent of increasingly diverse populations, facing many issues when it comes to the accessibility of its healthcare systems. We believe that maternal health must be a crucial factor when building resilient, effective and accessible healthcare systems. To quote President Juncker: “Our children deserve better.”
 Source: European Women’s Lobby (EWL), Factsheet on Women and Health, April 2015: http://www.womenlobby.org/spip.php?action=acceder_docu- ment&arg=4238&cle=60c8d7ee6f92fc58b53873cd67591c17ccbcb29e&file=pdf%2Ffactsheet_women_and_health.pdf
 Source: World Health Organization (WHO), Trends in Maternal Mortality 1990-2013, p. 51, 2014: http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1Blogactiv Team