The periods of labor and childbirth are critical moments when a joyful event can suddenly turn into crisis- consequently; there is need for medical attentiveness and preparedness.  The lack of proper medical attention in these periods leads to high burden of maternal deaths as well as large numbers of stillbirths and early newborn deaths.

Globally, about 3.2 million stillbirths, 4 million neonatal deaths and more than half a million maternal deaths occur annually. Up to 17% of maternal deaths occur during childbirth while 70% occur postpartum. Approximately 98% of these deaths occur in low- and middle-income countries, mostly due to obstetric complications in labor. Majority of these deaths are preventable.

Safe motherhood is a phrase that encompasses the series of initiatives, practices, protocols and service delivery guidelines designed to ensure that women receive high-quality care in order to achieve optimal health for the mother, fetus and infant during pregnancy, childbirth and postpartum. Maternal mortality can be prevented through safe motherhood and family planning- which reduces 25-40% of maternal deaths. Safe motherhood also decreases maternal and infant mortality or morbidity because most maternal and infant deaths can be prevented through safe motherhood practices. Identified health risks for maternal and child illness or death are poor nutrition, illiteracy, lack of income and employment opportunities, inadequate health and family planning services, and low social status. Several countries have been able to improve maternal and new-born health and well-being in the last few decades. However, developing countries- with the highest burden of maternal and infant mortality and morbidity have made the least progress. As a result, there is an increased inequality between countries and within countries.

Breast milk is the right food for babies; strong evidence exists that babies do best if they consume only breast milk for the first six months of life. Breast milk confers both short and long term protection from infections on babies. Exclusive breastfeeding- defined as continuous uninterrupted breastfeeding for a period of six months, provides more protection and is more likely to reduce the risks and severity of allergies. However, protection can still be achieved when breast milk is combined with some formula. Women who breastfeed their babies have lower risk of pre-menopausal breast cancer, ovarian cancer and osteoporosis later in life.

Major challenges for prevention include how to deliver services and scale up interventions, particularly to vulnerable, inaccessible, marginalized and excluded mothers and babies. Political will is essential at all levels, especially at national and district levels. Policy-makers and program managers need to shift their focus from the development of new interventions to the development of practical strategies that ensure the availability of care and account for every birth and death. Medical policies and practices that can reduce maternal deaths and improve women’s health are also capable and crucial for ensuring newborns’ survival and health. A major limitation in the overall progress of preventing maternal and infant mortality or morbidity is the gap between what is needed and what is available in terms of skills and resources at local, national and international levels. Other challenges include:

• Lack of emergency preparedness
• How to maintain stocks of drugs, supplies and equipment in the face of increased demand
• Inaccessibility or lack of transportation for people who live far away from care centers
• Ineffective referral
• Unavailability of round-the-clock quality services ,particularly emergency obstetric care

Ethics is defined as the systematic examination of the way humans treat and relate with each other as well as their surrounding natural environment… it is the study of the values and beliefs that guide people’s attitudes and behaviors. Irrespective of differences in social, cultural, economic or professional backgrounds, ethics is practiced by everyone on a daily basis.

Advancements in medical knowledge and technology come with significant moral challenges. Health ethics is the field of ethics that deals with health-related ethical and moral issues in health care, medicine and science. It involves discussions concerning choices of treatment and options of care that are faced by individuals, families and health care workers. It requires a critical evaluation of the programs, systems, and structures developed to improve the health of a population. Health care ethics is concerned with series of moral decisions- and most moral issues in healthcare are due to innovations and developments in reproductive and genetic knowledge and genetic technologies. Other areas of moral and ethical interest include:

• Relationship between health care professionals and their patients
• Biomedical and behavioral human subject research
• Harvest and transplant of human organ
• Abortion
• Allocation of health care services; deciding between clinical care or health promotion
• Making decisions about end-of-life care
• Equity in distributing healthcare goods and services
• Ethical conduct in health research
• Implications of genetic cloning and similar technologies

Health ethics involves reflecting on ways to allocate limited resources as well as the best decisions regarding complex moral options that result from continuous health care advancement. It also entails a critical, political, and ethical analysis of the definition and health determinants. Public health ethics on the other hand, involves a systematic process to clarify, prioritize and justify possible outcomes of public health actions based on ethical principles, values and beliefs of stakeholders or based on scientific information. It seeks to understand and elucidate the principles and values that guide public health actions and provide the framework for making and justifying decisions. Since public health actions are mostly taken by governments and are directed at the population level, the guiding principles and values differ significantly from those of biological and clinical medicine (bioethics and medical ethics) which are more patient or individual-centered. As a field of practice, public health ethics involves the application of appropriate principles and values to public health decision making. Using an ethics framework, public health ethics inquiry carries out three core functions:

• Identify and clarify ethical dilemma
• Analyze and compare alternative courses of action and their consequences
• Problem resolution by making a decision that best incorporates and balances the guiding principles and values.

One goal of public health ethics is to integrate the tools of ethical analysis into day-to-day operations. To achieve this, the basic principles of health care ethics are used, they’re highlighted below as guiding principles- Typically, for a medical practice to be considered “ethical”, it must respect these principles:

• Non-maleficence- The principle of non-maleficence- do no harm, emphasizes that health care professionals must act in ways that do not harm patients, even at their request

• Beneficence- This is the obligation to create or produce benefit for individual patients or clients. Every act by health workers must be performed with good intentions

• Health maximization- In public health, the principal outcome is the health of the public and improvements to this are the key outcome used to measure success

• Efficiency- There will always be more health need than available resources to deal with those needs. Hence, there is a moral duty to use scarce health resources efficiently.

• Respect for autonomy- The principle of respect for autonomy means that patients’ rights should be respected; however, it is not at the detriment of maximizing the health of the broader public.

• Justice- Justice and health equity demand equal opportunities which includes a fair distribution of health outcomes in societies

• Proportionality- It demands that in weighing and balancing individual freedom against wider social goods, considerations will be made in a proportionate way.

It is important to understand the leading causes of death because by measuring how many people die each year, the corresponding causes of their death and gauging how diseases and injuries are affecting people, the effectiveness and efficiency of the country’s healthcare system can be assessed. Additionally, the number and cause-of-death statistics help health authorities to determine their focus for public health actions; for instance, a country which experiences a sudden increase in the number of deaths from heart disease and diabetes in a few years, would strongly consider the initiation of vigorous programs to encourage lifestyles that help prevent these illnesses. Similarly, if a country realizes through cause-of-death research and statistics that many children die of malaria, the health budget can be adjusted to accommodate and increase spending in that area.

High-income countries have effective surveillance systems for collecting data on causes of death in the population but most low- and middle-income countries lack such systems, hence, deaths from specific causes are often estimated from incomplete data. Improvements in producing high quality cause-of-death data are crucial for improving health and reducing preventable deaths in these countries.

Leading causes of death differ across the world based on various factors including country, economy and developmental status, age group and income group. In low income countries for instance, over 70% of deaths are attributed to preventable causes such as communicable diseases (CD), pregnancy or childbirth complications and poor nutrition while in high income countries, only less than 10% of deaths are due to these causes. On the other hand, non-communicable diseases (NCD) cause about 88% of deaths in high-income countries and about 37% of deaths in low-income countries.

Considering only the absolute number of deaths, 78% of global NCD deaths occur in low and middle-income countries while some diseases such as lower respiratory infections occur across all income groups. Given the lack of development, infrastructures and basic amenities in low income and developing countries, injuries- especially due to road traffic accidents, claim nearly 5 million lives annually. Road injuries are also among the leading causes of death in the world. The global rate of road traffic accidents was 18.3% but low-income countries have the highest mortality rate with about 28.5% deaths per 100,000.

According to the latest statistics in 2016, there were about 56.9 million deaths worldwide. Over half of these deaths were attributed to ten top causes – with Ischemic heart disease and stroke as the biggest killers- accounting for a combined 15.2 million deaths in the same year. These diseases have remained the leading causes of death globally for 15 years. Chronic obstructive pulmonary disease claimed 3 million lives while lung cancer (including trachea and bronchus cancers) caused 1.7 million deaths. Diabetes killed 1.6 million people while deaths due to dementia more than doubled between 2000 and 2016, making it the 5^th leading cause of global deaths. Lower respiratory infections remained the most deadly communicable disease, causing 3 million deaths worldwide. Diarrheal diseases caused 1.4 million deaths while tuberculosis had a death toll of 1.3 million, coming in as the 8^th and 9^th leading cause of global deaths respectively. The 10^th cause of death was road injuries which killed 1.4 million people in 2016.

In the United States specifically, about 75% of all deaths are attributed to just ten causes, with the top three accounting for over 50% of all deaths. These ten leading causes of death are similar to the above named causes of death in the world and have remained fairly consistent. They include:

• Heart disease
• Cancer
• Chronic lower respiratory disease
• Accidents
• Stroke
• Alzheimer’s disease
• Diabetes
• Influenza and pneumonia
• Kidney disease
• Suicide

As the overall population ages and the Patient Protection and Affordable Care Act (PPACA) continues to expand health insurance coverage, policy makers must focus on the growing shortage of primary care workforce especially doctors. The shortage of doctors in the United States is a major concern facing and affecting hospitals, and patients in particular. This shortage subjects Doctors to a draining work environment and hectic lifestyle leading to constant burnout and an increased turnover rate which hospitals cannot afford. Consequently, it is essential to improve the quality of the work environment as well as reduce the workload of these doctors in order to retain them, sustain the quality of care received by patients as well as improve patient access to healthcare.

In recent years, physician shortage in the US has overwhelmed the healthcare industry and is expected to continue growing exponentially. Some reasons for this shortage include, but is not limited to population growth, increase in the number of aging Americans, and retirement of practicing doctors. A 2017 study by the Association of American Medical Colleges (AAMC) showed that the US could face an impending crisis of physician shortage to a maximum of 104,900 physicians by 2030. A crisis of physician shortage will be detrimental to patients and doctors; patients will experience longer wait times, barriers in accessing healthcare, dissatisfaction, distrust in the health system, and difficulties in getting beds or being admitted for extended hospital stays. Doctors on the other hand will be unable to treat patients efficiently due to fatigue from extended work hours and patient influx. More so, the shortage of physicians does not only affect hospital patients but also people who visit their primary care physicians and family doctors. Ultimately, the shortage of doctors will erode and negatively impact the overall quality of healthcare across the US if not averted.

In general, recent years have recorded significant decrease in patient care access due to a number of factors; however, some people propose that this decrease may not be as a result of physician shortage. A 2014 study by the Institute of Medicine claimed there was no statistical shortage of physicians or doctors in the US. As a consequence, there is need for further research to ascertain if there is indeed shortage, to what degree it exists and the possible impacts it could have on hospitals, doctors and patients.