Commentary: How medical students are striving for improved global maternal health
outcomes
Christine Osborne1 & Laurence Bernard2
1
2
MD Candidate 2013, Faculty of Medicine, University of Ottawa, cosbo035@uottawa.ca
MD Candidate 2014, Faculty of Medicine, McGill University, laurence.bernard2@mail.mcgill.ca
During our blocks in obstetrics and gynecology, two medical students fell in love with
delivering healthy babies to healthy mothers. Seeing a mother gaze into the eyes of her new
child for the first time is nothing short of spectacular. Healthy deliveries, without complications,
are common in Canada. If a complication arises, medical staff are available, trained, and have
the appropriate resources to deal with that obstacle. Unfortunately, this level of obstetrical
care is not the same across the world.
According to the World Health Organization, almost all maternal deaths (99%) occur in
developing countries.1 In order to tackle health inequalities such as this, in 2000 the Millennium
Development Goals (MDGs) were established - eight specific international health goals that all
193 United Nations member states have agreed to achieve by the year 2015. 2 MDG #5 is
“Improve Maternal Health” specifically 1) reduce by three quarters, between 1990 and 2015,
the maternal mortality ratio, and 2) achieve, by 2015, universal access to reproductive health. 3
Several years later how are we doing? In 2011 a report about the progress of the MDGs was
released. Many of the goals are still far from being met, and MDG #5, maternal health, has
been one of the least successful of all MDGs.3 Despite progress, pregnancy remains a major
health risk for women in several regions. The largest proportion of deaths are caused by
obstetric hemorrhage, eclampsia, sepsis, complications of unsafe abortion and indirect causes,
such as malaria and HIV. The vast majority of these are avoidable, yet, a very low proportion of
women are receiving the recommended number of parenatal visits. Thus the goal is not on
track, and it doesn’t look like it will be achieved by 2015.1,3
These statistics became more real to us during our travels when we met a medical
student from Nigeria. This student explained that in Nigeria many women will die during
pregnancy and childbirth. 4, 5 Children who survive have a high chance of death before the age
of five.6 These tragedies occur because of stigma, financial restraints, as well as lack of access to
appropriate, timely care. Unfortunately he himself had a loved one that died due to lack of
choice and lack of options. We both felt extremely honoured that he would share this personal
story with us; relative strangers from across the world. When we asked him why he shared this
he answered: “Because you will support me, while I support the health of my people; and I will
support you, while you support the health of your people.” This discussion motivated, as well as
humbled us. We were inspired to get more involved in improving the health of mothers,
newborns and children and reducing the number of preventable deaths. Our conversation
made us realize that we as medical students, as the future leaders in health care, can help to
improve burden of maternal health, and aim to work toward MDG #5.
In order to get more engaged in this topic we got involved with the International
Federation of Medical Students’ Associations (IFMSA). This is a non-governmental organization
that represents medical students from 100 countries, including Canada. It offers medical
students, and thus future physicians, with opportunities to learn more about global health
issues through medical exchanges, projects, as well as opportunities to attend general
assemblies.7 We attended two IFMSA General Assembly meetings: the August 2011 meeting in
Denmark, and the March 2012 meeting in Ghana. We used this opportunity to connect with
fellow medical students from all over the globe, sharing ideas and concerns about the one field
that makes us passionate, maternal health. In order to tackle this topic a small working group
(SWG) on maternal health was created. Delegates from Lebanon, China, the UK, the
Netherlands, Belgium, Switzerland, Sweden, Nigeria, Sudan, and Canada participated in at least
one of these two sessions, sharing their countries’ difficulties and success stories in the field, as
well as past and present initiatives that were undertaken by their peers and local organizations.
The education surrounding reproductive and sexual health was very diverse depending
on the region. One particularly interesting discovery was that several African countries had
religious leaders teach sexual education classes to medical students. Due to religious
restrictions students in these regions were not taught about abortion. In many of these same
countries students explained that deaths due to unsafe abortions were quite high. Conversely,
many of the European and North American students commented that while their teaching on
general obstetrics and gynecology was adequate for their home populations, many were lacking
education on global maternal health. Even within Canada it became clear that the education
was not standardized across all of the medical schools on topics of global health. Thus, medical
students all over the world had gaps in their knowledge surrounding global maternal health.
Since the sample was small it was decided that a larger understanding of the issue is required.
Thus a long term objective of this SWG is to: Conduct a global review of the content of medical
curricula regarding maternal and child health. Currently medical students from 8 countries are
working together to create a survey that can be distributed to the IFMSA affiliated countries.
The Partnership for Maternal, Newborn and Child Health (PMNCH) has agreed to review the
questionnaire before it is disseminated. The results will be published in the SCORA (Standing
Committee on Reproductive Health including AIDS) Magazine and the report will be issued to
the PMNCH and World Health Organization (WHO) through the IFMSA’s representative to the
WHO. It was agreed that the questionnaire should be the first priority of the group, who would
then act upon the results by creating peer education projects in their local medical schools and
communities, and lobbying their respective governments to work towards filling in these
educational gaps. Thus the second goal of the SWG was to: Continue to raise awareness on
maternal and child health issues, and report on our work on these issues. Through dissemination
of their projects at IFMSA meetings, and through IFMSA journals medical students from other
countries can become inspired to create change in their own country.
Thus through these initiatives, medical students are making a stand to improve MDG #5.
It is our aim to prevent the complications during pregnancy and childbirth, including unsafe
abortion through education of medical students and the communities they live and work in.
Medical students might not have the strongest voice yet, but with our collaboration we can
make MDG #5 a reality. As an intelligent man said - “You will support me, while I support the
health of my people; and I will support you, while you support the health of your people.” This
is a motto that we need to continue to uphold as we strive for improved global maternal health
outcomes. Student involvement and collaboration in medical education is essential to success.
References:
1) The World Health Organization, 2010. The Millennium Development Goal Report 2010
Addendum 2. Geneva, Switzerland.
2) The United Nations Development Programme, 2005. Investing in Development Report.
London, UK.
3) World Health Organization, 2011. Millennium Development Goals: progress towards the
health-related Millennium Development Goals, Fact sheet N°290. Geneva, Switzerland.
4) National Planning Commission (NPC) and United Nations Children’s Fund (UNICEF), 2002.
Child Survival in Nigeria: Situation, Response, and Prospects. Ibe: NPC and UNICEF. New York,
USA.
5) World Health Organization, 2010. Trends in Maternal Mortality: 1990 to 2008 Estimates
developed by WHO, UNICEF, UNFPA and The World Bank. Geneva, Switzerland.
6) Hill K, et al. Estimates of maternal mortality worldwide between 1990 and 2005: an
assessment of available data. Lancet, 2007, 370(9595):1311-1319.
7) Van Minde, M. (2010). International Federation of Medical Students. Presented for Medical
Students Worldwide. Copenhagen, Denmark.