Improving Maternal Health Via Water, Sanitation And Hygiene

By Eranga Isaac - 08059233001
ALTHOUGH the estimated number of maternal deaths fell from 543,000 to 287,000 between 1990 and 2010, few countries are on track to meet millennium Development Goal 5, which aims to reduce by three quarters the maternal mortality ratio, states WHO/UNICEF (2012) count down 2015. According to wateraid.com, further progress on maternal health will require a redoubling of efforts, especially as maternal deaths are most likely to occur within the most vulnerable and hard-to-reach populations. For example, the partnership for maternal Newborn and Child Health (2011) PMNCH fact sheet: RMNCH continuum of care: Reproductive, Maternal, newborn and child health, states that African women’s risk of pregnancy- related death, over their lifetime, is 100 times higher than that of women in developed countries.   Efforts to tackle maternal mortality have focused on the continuum of care approach starting with reproductive health, with specific interventions targeting the antenatal to postnatal stages but with little focus on wider social and environmental determinants. Achieving greater reductions in maternal mortality and improvement in reproductive health may require more integrated approach. One potentiality important consideration is the role of safe drinking water, safe sanitation, and the practice of good hygiene. There is currently a limited understanding of how water sanitation and hygiene (WASH) may influence maternal health and, partly as a result of this, it does not generally feature in existing global or national strategies for improving maternal and reproductive health. Access To WASH – Still a Distant Goal According to UNICEF/WHO (2013) progress on drinking water and sanitation: 2013 update, Globally, 768 million people lack access to safe water, while 2.5 billion people do not have access to a safe toilet and about 1 billion practice one defecation. The World Health Organization (WHO) estimates that inadequate WASH is responsible for almost one tenth of the global disease burden. The key risk associated with poor WASH is diarrhea disease mortality and acute morbidity. According to Liu L, Johnson H, cousens Setal (2012) ‘Global, regional, and national courses of child mortality, published in Lancet; 379 (9832): 2151-61, Diarrheal diseases account for 10% lf all child deaths and are the second leading disease cause of under – five deaths. Morbidity has declined only slightly since 1990. There is good evidence for the effect of WASH on a range of other health outcomes, including acute respiratory infections, soil-transmitted helminth infections, and diseases associated with the chemical contamination of water. Wash and maternal health – Social and cultural determinants: Lack of access to water and sanitation a disproportionately affects woman and girls, who often bear the greatest burden in the absence of reliable water and sanitations services. Two-thirds of drinking water is collected by women, says UNICEF/WHO (2011). And the financial and opportunity costs of obtaining and treating water, doing house work, and treating WASH – Related illnesses can consume a significant share of poor families resources. In Africa, it is estimated that water collection accounts for 40 billion hours a year, says Bardsi E and Wodon Q(2006) in Measuring time poverty and analyzing its determinants: concepts and application to Guinea. World Bank, and Lawson D (2007) in A Gendered analysis of ‘time poverty’ and the importance of infrastructure, Global Poverty Research Group, Manchester, UK. In Pakistan, the long distance to water sources leads to reduce participation in income-generating activities by women. Lack of access to safe sanitation results in open defecation, or the use of shared toilet facilities. For women, this often takes place after dark, to retain modesty and privacy, making it more difficult to manage menstruation and exposing them to the risk of harassment, attack and rape. Lack of separate and adequate sanitation facilities, including provision for management of menstrual hygiene in schools, may also contribute to absenteeism and drop out rates, which, in turn, are associated with a greater risk of early marriage and pregnancy. Direct Impact on Maternal and Reproductive Health There are many direct links between WASH and maternal and reproductive health. In a forthcoming systematic review, these links are broadly grouped under two headings: WASH – related contamination and infection, and behavioural factors related to the quality and location of facilities. Preliminary findings from this review suggest multiple and complex linkages between WASH and maternal and reproductive health.