Rural women play a critical role in the rural economies of both developed and developing countries through their activities in agriculture and rural enterprises which contribute to local and global economies. But they are disadvantaged in accessing emergency obstetric and neonatal care, because of geography, local support, autonomy, culture, finance, and ergonomics. This contributes to higher maternal mortality rates.
Rural women and millennium development goalsRural women are active players in achieving the Millennium Development Goals (MDGs). They play a critical role in the rural economies of both developed and developing countries through their activities in agriculture and rural enterprises which contribute to local and global economies.Rural women play a key role in supporting their households and communities in achieving food and nutrition security, generating income, and improving rural livelihoods and overall well-being.In addition, they carry out vital functions in caring for children, older persons and the sick.Most people who live in extreme poverty live in rural areas of developing countries, and rural women fare worse than rural men and urban women and men for every MDG indicator for which data are available.Read the full MamaYe Facts and Figures on Maternal Health and Rural Women here.Rural women and maternal healthAchieving MDGs 4 and 5 to reduce child and maternal mortality are of particular importance to women living in rural areas. Because of the location of their homes, rural women are disadvantaged in accessing emergency obstetric and neonatal care, because of geography; local support; autonomy; culture; finance; and ergonomics.When unpredictable complications happen during pregnancy or delivery, women need urgent medical care. For women living in rural areas they have more challenges in reaching medical treatment and this contributes to higher maternal mortality rates.Additionally, early marriage is more common among rural communities and often leads to early childbearing, with negative health consequences for young women, including obstructed labour and obstetric fistula, which is more common among women from rural areas.Inequity in maternal health servicesIt is important for all pregnant women to have access to a skilled birth attendant at the time of delivery, and is the "single most important factor in preventing maternal deaths”. Skilled attendance at birth is also critical to prevent stillbirths and to improve newborn survival.Women living in rural areas have more births that those in urban areas; the average number of births per woman (fertility rates) are higher among women in rural areas.Yet the proportion of women with skilled birth attendance (SBA) and delivering in health care facilities are two of the indicators of the MDGs that are most inequitable in coverage.Across the MamaYe countries, more women live in rural than in urban areas, yet fewer women give birth in health facilities and in attendance by a skilled birth attendant than their urban counterparts. The graph below shows results comparing the proportion of births that occur in a health facility (institutional births) among rural and urban, and rich and poor from a study of 30 countries.It shows that rural living confers a distinct disadvantage in accessing health facilities for deliveries including in MamaYe countries like Ethiopia, Tanzania and Ghana. In Nigeria, most rural women are disadvantaged compared to their urban counterparts, although there is a growing population of urban poor who also have less access to facility deliveries. In sub-Saharan Africa, this contributes to a far higher maternal mortality ratio among rural women of 640 per 100 000 livebirths compared to their urban counterparts at 447 deaths per 100 000 livebirths.What is needed?To reduce the inequity in maternal health outcomes for rural women, all rural women should have access to adequate health care facilities as stated in the Convention on the Elimination of All Forms of Discrimination against Women.We know that providing women with skilled attendants in a health facility is what works to reduce maternal mortality; that means safe clinics and more midwives.To make the fastest progress, strategies to scale up interventions aimed directly at the poorest should be adopted.Greater investments in health are required; studies have shown that a 10% increase in spending on health can result in a decrease of maternal mortality of 5%.This blog was originally written for International Day of Rural Women in 2013, and has been updated for 2014.Key referencesLawn JE, Cousens S, Zupan J: 4 million neonatal deaths: When? Where? Why? Lancet 2005, 365(9462):891-900.Matthews Z, Channon A, Neal S, Osrin D, Madise N, et al. (2010) Examining the ‘‘Urban Advantage’’ in Maternal Health Care in Developing Countries. PLoS Med 7(9): e1000327. doi:10.1371/journal.pmed.1000327