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Safe Surgery Globally by 2030: The Essential Role of Anesthesia, The View From Obstetrics.

April 2018 • Volume 126 • Number 4 www.anesthesia-analgesia.org 1109 DOI: 10.1213/ANE.0000000000002561 Meaningful progress has been made in reducing maternal mortality during the years of the Millennium Development Goals with global maternal deaths declining by nearly half (44%) since 1990, accompanied by a marked increase in the use of maternity services.1 In countries where the changes in maternal health have been significant, there has been improvement in health care generally, with systemic strengthening of health care infrastructure. However, progress has been uneven, and the Millennium Development Goal 5 target of a 75% reduction in maternal mortality is still to be met. Most of these deaths occur in lowand middle-income countries (LMICs). Many of the major causes of maternal death are amenable to emergency surgical treatment, including hemorrhage (18%),1 obstructed labor (8%),1 unsafe abortion (18%),1 in addition to uterine rupture, genital tract trauma, retained placenta, and ectopic pregnancy. Anesthetic providers are also integral to the resuscitation and management of critically ill pregnant and postpartum women including sepsis and preeclampsia/eclampsia, responsible for 9% and 12% of maternal deaths, respectively.1 Furthermore, the World Health Organization (WHO) recommends that countries should achieve cesarean delivery (C-section) rates of 10% at a population level, to achieve reductions in maternal and newborn mortality rates.2 In most low-income countries (LICs), the C-section rates are typically lower than 5%, except for pockets of private care, where, ironically, the rates are sometimes much higher than recommended. In LICs, women may wait for many hours for an emergency C-section due to lack of availability of anesthesia personnel.3 The global distribution of fully trained surgeons, anesthesiologists, and obstetricians (SAO) is not only critically inadequate in many parts of the world but also grossly inequitable between and within countries.4 Many of the greatest gaps in care are in Sub-Saharan Africa (SSA) and South Asia.