The impact of maternal health on poverty

The links between poverty and poor maternal health are well established. Poorer countries experience the highest rates of maternal mortality, whilst maternal death and life-threatening and debilitating illness are higher among women from poorer households. However, there is now growing evidence that poor maternal health can also exacerbate poverty.

Out-of-pocket spending on maternal health care can impose a significant financial burden on households and contribute to impoverishment. In Rajasthan, India, the costs of antenatal and postnatal care constituted 2.4 percent of total annual household spending in the late 1990s. The costs of a normal delivery in Bangladesh were approximately one month's income in 2004.

For a healthy pregnancy, women have to pay further costs, including travel expenses for antenatal visits and payments for consultations. Whilst these expenditures may not necessarily be related to poor health, costs are usually higher if there are complications, involving additional expenditures including medicines, laboratory tests and hospital visits.

If these complications lead to a stay in hospital, out-of-pocket expenditures can escalate rapidly. A recent review by the World Health Organization (WHO) found that the direct costs of maternal health care range between one and five percent of total annual household expenditures, rising to between five and 34 percent if the woman suffers a maternal complication.

There may also be costs in terms of the loss of earnings, both for the woman herself, family members who may accompany her to hospital and other carers who step in to provide care for children at home. Households often have to borrow money, forcing them into debt. Taken together, the costs of pregnancy and poor maternal health can push a family into poverty or further impoverish families already living in poverty.

If poor maternal health results in a woman dying, then families could be driven deeper into poverty due to the direct costs of the funeral and the subsequent loss of earnings. In many industrialised countries this cost is often borne by life insurance, but in developing countries, most insurance is 'informal' (often dependent on friends and family support) and not guaranteed.

There is also evidence of longer term costs in terms of the lifelong absence of a mother and the subsequent impact on care for children. Children who lose their mothers can perform poorly at school. In many cases older children will be taken out of school and younger children may not go to school. In Indonesia between 1993 and 1997, a study of 2,513 children aged 6 to 10 showed that 14 percent of bereaved children dropped out of school compared to only 7 percent of non-bereaved children. Poor performance in school can then lead to these children being more likely to live in poverty as adults.

Worse still, there is some evidence that maternally orphaned children, and particularly girls, face a higher risk of malnutrition and premature death. The same study in Indonesia suggested that maternally orphaned children are approximately four times more likely to die compared to non-bereaved children.

As well as affecting individuals and households, these factors can lead to increased poverty at the community and country level by depleting the workforce and resulting in lower productivity leading to lower gross domestic product (GDP). A 2006 WHO study estimates totals of US$95 million and US$85 million are lost each year by Ethiopia and Uganda respectively.

These associations between maternal health and poverty highlight the importance of maternal health interventions as tools for tackling poverty as well as for reducing maternal ill health in its own right.

Jane Falkingham
Faculty of Law, Arts and Social Sciences, Murray Building, Southampton University, Highfield, Southampton SO17 1BJ, UK
T +44 (0) 23 80593192
F +44 (0) 23 80593846
j.c.falkingham@soton.ac.uk

See also

'The Tremendous Cost of Seeking Hospital Obstetric Care in Bangladesh', Reproductive Health Matters 12(240), pages 171-80, by Kaosar Afsana, 2004
www.rhmjournal.org

'Household Expenditures on Reproductive and Child Health Services in Udaipur, Rajasthan', by David R. Hotchkiss et al, in Financing Reproductive and Child Health in Rajasthan, Jaipur: Indian Institute of Health Management Research and The POLICY Project, The Futures Group International, 2000
www.policyproject.com/pubs/countryreports/IND_RAJ_FIN.pdf

'The Presence and Presents of Parents: How Parental Death and Disability Affects Children', Haas School of Business, University of California, Berkeley working paper, by Paul Gertler, David Levine, and Sebastian Martinez, April 2007

Moving Towards Universal Coverage Series, World Health Organization, 2006
www.who.int/reproductive-health/universal_coverage

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