Reducing Maternal Mortality in Papua New Guinea: Contextualizing Access to Safe Surgery and Anesthesia

Abstract

(Anesth Analg. 2018;126(1):252–259) Papua New Guinea (PNG), a low–middle-income country with a population of 7.6 million and a poverty ranking of 158 of 188 countries, has an estimated maternal mortality rate of 215 (range, 98 to 733) per 100,000 live births. This is one of the world’s highest maternal mortality rates, with the comparable statistic in Australia being 7.1 deaths per 100,000 live births. Reasons for maternal death in PNG are not limited to pathologies usually associated with maternal death, such as obstetric hemorrhage, sepsis, high blood pressure, etc., but also to fundamental in-country systemic issues, including leadership and governance, a dispersed population in the rural highlands, shortage of health workers, limited access to water and information systems, fragile health infrastructure, poor focus on the social determinants of health, and limited access to safe surgery and anesthesia. Therefore, addressing pathologies that result in death will have little impact on the maternal mortality issue in PNG. Instead, as discussed by the World Health Organization’s 2015 publication on “global strategy for women’s, children’s, and adolescent’s health,” key areas for improvement in maternal health lie in strong country plans, integrated health delivery services, life-saving interventions and commodities, adequate number of skilled and well-equipped health workers, access to safe surgery and anesthesia, and improved monitoring/evaluation/accountability. The authors of the present narrative discussed the current situation in PNG and possible approaches to reducing maternal mortality via a discussion of enabling environments and key times for intervention.