Women's Health and Surgical Care: Moving From Maternal Health to Comprehensive Surgical Systems.

J Obstet Gynaecol Can 2015;37(10):894–896 O the past 25 years, the maternal health community has made significant progress in reducing the number of women who die from complications of pregnancy and childbirth globally, a number which fell from approximately 376 000 in 1990 to 293 000 in 2013.1 Since 2003, improvements have accelerated as coordinated systems and public education efforts have found a place in communities around the world.1 By 2010, maternal disease and complications of pregnancy and delivery had fallen from the 11th to the 23rd most common cause of mortality in women.2 The global expansion of comprehensive emergency obstetric care, including timely Caesarean section, has been the cornerstone of efforts by the international community to reduce maternal morbidity and mortality. As exciting as this progress has been, it is increasingly apparent that focusing solely on pregnancy and childbirth will fail to resolve systemic barriers to surgical care for women, which may prevent further health, welfare, and economic gains.3 A growing burden of non-communicable diseases far outmatches the surgical care presently provided to women, many of whom are made especially vulnerable due to their social context and environment. The opportunity has been given to us to mobilize global, national, and community-level commitment to establish an agenda for women’s health and surgical care that is comprehensive and considers a woman’s entire life course. Using new data from three landmark global health documents, we argue that comprehensive women’s health requires strong, resilient surgical systems that treat surgical disease in women across all diagnostic categories.2–4 The Lancet Commission on Global Surgery is an open process to advance surgery as a universal public health measure.3 The Commission found that five billion people lack access to safe, affordable surgical and anaesthesia care, and that a minimum of 143 million additional procedures are required to meet the current global burden of surgical disease. Furthermore, 33 million individuals each year are faced with catastrophic expenditure after receiving surgical care, and without an urgent scale-up of surgical and anaesthetic care, surgical disease will cost the world economy US$ 12.3 trillion between 2015 and 2030.3 Drawing on remarks by the President of the World Bank, LCoGS concluded that “surgery is an indivisible, indispensable part of health care.”