Greater investment in water, sanitation, and hygiene (WASH), is an area that has been overlooked, and yet has potential to improve maternal and newborn health (MNH). WASH refers to “improved water quantity and quality, sanitation, and hygiene” and can prevent or minimise the transmission of disease. Although there is a paucity of rigorous research quantifying the effects of WASH interventions on MNH outcomes, the little evidence suggests that WASH could improve MNH.
In many low-income countries, access to improved water and sanitation is limited in health facilities. A case study from Bo District Hospital in Sierra Leone demonstrates that increased investment in WASH by the international and national community can result in substantial improvements in service quality. This in turn improved the uptake of health services and health outcomes. Three months after the investments in infrastructure and staff training, post-caesarean wound sepsis decreased from 60% to 10% and rates of admissions for facility deliveries doubled.
It has therefore become increasingly necessary to adopt national MNH policies that put water, sanitation and hygiene at its core. A factsheet produced by the MamaYe Campaign and WaterAid in 2015 highlights the latest evidence on the link between WASH and MNH. Good progress has been made since the 1990s in reducing the deaths of children under-five years of age. Yet, despite this progress, much less attention has been paid to addressing deaths during the first 28 days of life – the neonatal period. In 2013, 2.8 million babies died worldwide during the neonatal period. This represents two out of every five child deaths. Similarly, maternal mortality has remained high in many settings.
Every year, an estimated 289,000 women die worldwide from complications during pregnancy, delivery, and after the birth. A study published in the Bulletin of the World Health Organization (2013) reveals that, for each deaths, 20 or 30 other women experience short or long-term physical or mental disabilities. According to the 2014 World Development Indicators published by the World Bank, the lifetime risk of maternal mortality is 1 in 38 in sub-Saharan Africa, compared to Europe’s life time risk of 1 in 9,000.
The fact is, almost all maternal deaths take place in low-income settings and could be prevented, and improvement(s) in water and sanitation is one way through which the health of mothers and babies could be improved, and their lives saved.The links between maternal health and water and sanitation are multiple and occur not only during the continuum of care from pregnancy, to delivery, and the postpartum period, but also throughout the life of the mother and her child. However, access to clean water and improved sanitation is often insufficient, with poor households and health facilities often lacking access to adequate water sources and sanitation.
Despite the fact that globally the Millennium Development Goal 7 target on water was met in 2010, 748 million people worldwide still relied on unimproved drinking water sources in 2012, 43% of whom are living in sub-Saharan Africa. The UNDP has stated that Ghana is on track to achieve the target on halving the proportion of the population without access to safe water. This notwithstanding, the UNDP surmises that “critical challenges exist in achieving the targets of reversing the loss of environmental resources, reducing the proportion of people without access to improved sanitation, and achieving significant improvement in the lives of people living in slum areas”.Access to adequate, safe water and sanitation is important throughout pregnancy, and significantly contributes to the well-being and health of Ghanaian mothers and their newborns. There are ways in which water and sanitation contribute towards good health during pregnancy.
Access to water : Lack of access to water impacts on maternal health through the physical burden associated with collecting water. Women and girls are typically tasked within households to collect water. Pregnant women that have to walk long distances and carry heavy jerry cans of water are at an increased risk of complications throughout pregnancy. In addition to this, having to collect water means there is typically insufficient amounts of water in the household to maintain hygiene, and that water is stored in-house, increasing the risk of water contamination (Howard & Bartram, 2003). Pregnant women are more vulnerable to WASH-related diseases and infections associated with poor hygiene and water contamination.
Water quality : Safe water is key to preventing the transmission of a range of bacterial, viral and parasitic infections that have particularly negative impacts on pregnant women. For example, hepatitis E, transmitted through faecal contamination of drinking water, is proven to have more severe consequences in pregnant women than for the broader population. Chemical contamination of water also puts pregnant women at risk. For example, water contaminated with arsenic is known to increase the risk of anaemia, which in turn puts pregnant women at higher risk of severe bleeding.
Access to sanitation : Maternal conditions such as stunting and anaemia, which negatively impact maternal and newborn health outcomes and, according to a study published in The Lancet (2008), account for at least 20% of maternal deaths, are intimately related to a lack of WASH, particularly sanitation. For example, a WHO study published in 2008 indicated that approximately a quarter of all stunting can be attributed to 5 or more episodes of diarrhoea before two years of age, and it is known that 88% of cases of diarrhoea are directly related to inadequate WASH.Similarly, helminth (worm) infections are one of the causes of maternal anaemia. Adequate sanitation is vital to interrupting the transmission of diarrhoeal and helminths diseases, as they thrive in faecal contaminated environments.
With 2015 sprinting to an end, national governments must ensure that WASH are embedded in all plans for reducing newborn deaths, standards for maternal and neonatal care and in broader health systems plans that encompass any or all of these objectives.
Closely related to this is the need for Ghana’s government to implement the Every Newborn Action Plan in its entirety, with particular focus on WASH. There is a need for a multisectoral approach at implementing the strategies put out in the newborn action plan if real progress will be made.
Essentially, all African leaders must prioritise adequate financial resources to WASH. These resources should not only cover costs for infrastructure, but ensure WASH is sustainable, accessible and affordable in households and health facilities.
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