Women's health: Global access and care

Half of all maternal deaths occur during or within 24 hours of delivery. Common causes of maternal death include postpartum hemorrhage, reproductive tract infections, eclampsia, complications from unsafe abortion practices, obstructed labor, and serious infectious diseases. Serious, untreated complications during pregnancy or delivery can be fatal to both mother and infant.

Maternal health care is vital to reduce maternal mortality and suffering, and it includes access to safe abortion care. Unsafe abortion is the only main cause of maternal death that is almost entirely preventable.

Emergency obstetric care is a key component of MSF’s strategy to reduce maternal mortality, and its rapid implementation is incorporated in our response to crises such as conflicts or natural disasters.

Diseases like malaria and hepatitis E are particularly dangerous to pregnant women. Hepatitis E has a fatality rate of 25 percent for pregnant women, and increases the risk of spontaneous abortion, stillbirth, and neonatal complications. To combat hepatitis E, MSF and our partners have carried out mass vaccination campaigns that prioritize pregnant women.

Pregnant women with malaria face a higher chance of developing complications that can end in miscarriage or cause fetal growth restriction. Pregnant women with malaria are also at increased risk of dying, becoming severely sick, and developing anemia. MSF recommends preventive malaria care at routine prenatal care visits after the first trimester.

Sexual violence includes rape, sexual abuse, and sexual exploitation, as well as forced sterilization and female genital mutilation. The majority of victims are women and children.

Sexual and gender-based violence can bring a wide variety of consequences for physical and reproductive health, including physical injuries, severe psychological distress, unintended pregnancy, and sexually transmitted infections (STIs) such as HIV.

In many of the contexts where MSF works, cancer screening and treatment remain out of reach and unaffordable. This means that many of the patients who do manage to reach us for breast or cervical cancer treatment are often in an advanced stage of the disease. In sub-Saharan Africa, where 2.2 million new cases of cancer are estimated by 2040, cervical and breast cancers are the most common types.

Cervical cancer is the deadliest form of cancer for women in many low- and middle-income. HIV-positive women are at much higher risk of cervical cancer, so we make an effort to reach these patients in particular.

Obstetric fistula is a preventable but devastating childbirth injury that usually arises from prolonged, complicated, and unattended labor. Women living in poor, remote areas without access to skilled maternal care are most vulnerable to this condition.

An obstetric fistula is a hole between the vagina and the bladder or rectum, through which urine or stool leaks continuously. Women and girls with untreated fistula may be stigmatized and excluded from family and community life, which adds to their suffering.

Around the world, HIV affects people of all genders. But in many of the places where MSF works, women are more at risk of contracting and suffering from the disease. In sub-Saharan Africa, for example, 60 percent of people living with HIV are women.

Women with HIV must also worry about transmitting the virus to their children. Over 90 percent of children living with HIV were infected by their mothers during pregnancy, birth, or breastfeeding.

MSF has demonstrated that simple, inexpensive interventions carried out by trained health professionals could have saved many of the 830 women who die every day from pregnancy-related causes.

Our maternal health programs in more than 25 countries focus on reducing maternal and infant mortality through pregnancy and prenatal consultations, emergency obstetric care, postnatal follow-up, access to family planning services, and safe abortion care.

To help reduce barriers that women face accessing to accessing emergency obstetric services, we adapt our work to local cultures, aim to locate services close to the people who need them, and (as with all MSF programs) provide care free of charge, as our patients are often among the poorest in their communities.

Sexual violence can occur anywhere, at any time. That’s why we strive to ensure that all of our projects can respond to sexual violence cases. In some places with high levels of sexual violence—for example, in Papua New Guinea, Colombia, Kenya, and Democratic Republic of Congo—our projects include dedicated services for survivors of sexual violence around the clock.

We strive to offer a comprehensive package of care for people who have been subjected to sexual and gender-based violence, including medical treatment for physical injuries, preventive interventions, and mental health care. MSF’s mental health support for survivors includes initial counseling to help patients deal with shock, as well as counseling and follow-up care to prevent or manage post-traumatic stress.

MSF rolls out health care campaigns that pair breast and cervical cancer screenings in areas where routine access to care is often unavailable for women. MSF also provides education on how to conduct breast self-examinations to detect early-stage cancer. Early diagnosis is essential to improving a patient’s chances of survival, particularly for breast cancer.

We also carry out vaccination campaigns against the human papillomavirus (HPV), one of the main causes of cervical cancer. In 2019, we vaccinated 13,000 girls in Zimbabwe against HPV.

Prevention of mother-to-child transmission (PMTCT) can reduce the likelihood of HIV transmission to under 2 percent. MSF integrates PMTCT in regular mother-and-child care services in places with medium- to high-HIV rates. These prevention measures include testing and providing antiretroviral (ARV) drugs to HIV-positive women as well as counseling, breastfeeding advice, and preventive ARV drugs for newborns.