As maternal and newborn carers most of us are so focused on the steady stream of mothers and babies passing in front of us, needing our attention and often developing problems and emergency situations that can consume us and sometimes overwhelm us – such that we can rarely reflect on the fact that “The differences in maternity outcomes between the rich and the poor, both between and within countries, - are larger than is any other area of healthcare” (UN millennial project). The figures from our region make this point very clearly: perinatal mortality in rural Melanesia can be as high as 80/1000, at Port Moresby General Hospital, it is about 20/1000 and in Australia and New Zealand it is 8; a factor of 2-10 times. At the same time the Maternal Mortality Ratio figures in rural Melanesia can be as high as 900/100,000 births, at first referral hospitals in the Pacific it is usually about a 100 and in Australia and NZ, it is typically less than 10; a factor of 10-100 times.
With regards lifetime risk of maternal death (estimated to be 1:30 in PNG and only 1:10,000 in Australia/NZ) the figures are even more extreme (i.e. a factor of a difference of 1:300+). With limited resources one needs to be very smart in allocation of time, human and material resources to achieve the best possible results for women, babies and families: to various degrees this maxim applies to MCH services all over the Pacific. In our circumstances, inappropriate allocation and use of resources can easily lead to worse outcomes for our patients and communities. There are examples (from all over the developing world, including our Pacific region) – even when we have the very best of intentions, mistakes in resource allocation and use of resources and application of care protocols can lead to worse outcomes.