Let’s Figure out how to Improve Women’s Health Across the Globe

Authors: Adrian Billings is the Associate Dean of Rural Health Professions at Tech University Health Sciences Center – Permian Basin. Muhammad Ahmad Saddiq is the CEO and Founder of Rural Health Mission Nigeria. They are both Senior Atlantic Fellows for Health Equity.

Last month, the World Health Organization reported that after 20 years of a progressive decline, the global rate of maternal mortality is increasing. While mortality is particularly high in many parts of the world such as Sub-Saharan Africa, mortality is also on the rise in the United States and Europe.

As health care providers who have dedicated our lives to women’s health, these rates are no surprise to us. We share with you a tale of two locales that demonstrate what the WHO statistics reflect — separated by thousands of miles, yet with similarities that make the sites initially difficult to distinguish.

In the first, women sometimes deliver their babies in an open field, or on a bare floor in the toilet behind the house. Pregnant women in the area must walk at least 30 miles just to access perinatal care services in a neighboring village.

In the second, pregnant women often have to drive 150 miles to a hospital during active labor. Once they arrive at that hospital there are often no available labor and delivery nurses. They then have to travel up to 200 more miles to deliver their baby via a small uncomfortable fixed-wing plane, and only if the weather permits such a trip.

The first community is located in the village of Kabri in Northeast Nigeria. It is one of the most remote and isolated communities in the country. Roads to the village are not traversable by car; residents either walk or use a motorcycle to navigate rocky hills and muddy valleys.

The second community is in the rural Big Bend of Texas in the United States, located near the Texas-Mexico border. Due to a lack of labor and delivery nurses to fully staff the unit, this rural critical access hospital now has limited obstetrical services to four days a week, leaving women who deliver on other days without access to a labor and delivery unit in this vast frontier region.  Half of community rural hospitals like this one  provide no maternity care at all.

We write from different continents with two different experiences — as a rural nurse in Nigeria and as a family physician in Texas. Yet, we face a common global dilemma — women’s health is under threat worldwide.

One of the most enduring threats is the risk of complications during and after labor and delivery. Postpartum infections are the leading maternal related cause of death in the world, and these rates are most severe in under-resourced areas. In Nigeria, these infections can lead to significant complications and even worse, death of the mother. In the United States, women who are low income, lack insurance and who are from minority backgrounds are at the highest risk.

So what can be done? These causes of morbidity and death are highly preventable. We need to leverage community, governmental and non-governmental resources. Some organizations offer capital support such as providing kits to local residents to support clean deliveries. Others are building satellite facilities in rural areas to provide access sites for delivery, reducing the need for women to have to travel for care.

However in addition to capital support, we also have to strengthen our health care workforce to ensure we have individuals who can utilize these additional  resources.

Efforts need to be made to reduce the problem of brain drain in which skilled and experienced  members of the healthcare workforce leave an area to work in more lucrative environments. Nigeria, for example, lost over 9000 physicians to places like the United States, Canada and Europe from 2016-2018, severely crippling its ability to provide access to health care.  Many rural areas in the United States are considered medically underserved areas and specifically maternity care target areas often due to providers migrating out of the area. In the Big Bend of Texas, over a seven month period in 2021, five of the area’s 10 physicians left to practice elsewhere.

We must train providers to practice in rural areas and offer the proper incentives for them to work there — including loan repayment and salary support. Providing training from the early stages of education to develop a rural health care workforce can supply providers that can serve their own communities. 

We also need to strengthen our women’s health workforce through training ancillary and lay health workers. Many low and middle income resourced countries have trained local midwives and community health workers to fill the void left by a shortage of obstetrical providers. In the U.S., a similar gap has been filled with training doulas in the provision of care for women in rural areas.

In rural areas around the world, it is clear that greater focus on improving women’s health is needed. Women deserve quality medical care, regardless of where they live, their transportation options or when they may need services.