“Some very basic elements of human development related to water, sanitation and hygiene that were accepted in the 19th and early 20th centuries are still unavailable to a large proportion of pregnant women in the 21st century”, write the authors of a new Simavi study .
Each year 290,000 women die from complications during pregnancy, birth and the neonatal period; and, an estimated 10 to 20 million women suffer from related health complications. Almost 90% of the maternal deaths occur in Sub-Saharan Africa and South Asia. Much of this is preventable through practices that have long been established.
The Simavi study reviews published literature describing the impact of water, sanitation and hygiene on maternal health and mortality.
Two studies showed significant correlations between increased access to water and sanitation and reductions in maternal mortality. Specific evidence was found relating to the impact of water carrying and water and sanitation-related infections on pregnant women, and to the impact of hygiene during and after delivery.
However, relatively few high quality studies were found on the basis of which generalisations can be made about the specific linkages between water, sanitation and hygiene on the one hand and maternal health on the other.
There was much more literature on the impact of hygienic practices during delivery on neonatal mortality. Clean delivery procedures are key to preventing neonatal deaths. Unhygienic practices during delivery that cause death of the newborn baby are also likely to have an impact on the health of the mother.
Even though it is clear how important is for mothers to have access to safe water, sanitation and clean birthing, they often have little influence on expenditures and decisions that would improve these services.
The study suggests that the educational/promotional aspects relating to WASH and (maternal and newborn) health should be improved and addressed from pregnancy up to child care. Similarly, health centres and hospitals should have running water, clean toilets, safe refuse disposal, clean beds and areas for deliveries. Consistent hygiene in clinics and hospitals should be ensured. More high-quality research is needed on the linkages between WASH and maternal health in the context of low-income countries.
Getting it right was written by Kathleen Shordt and Eefje Smet, consultants for the IRC International Water and Sanitation Centre. Kathy Herschderfer, senior advisor from the Royal Tropical Institute in Amsterdam reviewed the report.
Simavi is a Netherlands-based public health NGO with projects in Asia and Africa.
 Shordt, K., Smet, E. and Herschderfer, K. 2012. Getting it right : improving maternal health through water, sanitation & hygiene. Haarlem, The Netherlands: Simavi. ii, 31 p. : 3 fig., photogr. 98 ref. Available at: <www.simavi.nl/assets/Uploads/Simavi-Publicatie_Getting-It-Right.pdf>