Maternal Health and Mortality
Maternal health is the health of women during pregnancy, childbirth, and the postpartum period. It encompasses the healthcare dimensions of family planning, preconception, prenatal, and postnatal care in order to reduce maternal morbidity and mortality. (1)
The United Nations Populations Fund (UNFPA) estimated that 303,000 women died of pregnancy or childbirth related causes in 2015. (2) A majority of them died from severe bleeding, sepsis, eclampsia, obstructed labour and the consequences of unsafe abortions — all causes for which there are highly effective interventions. The risk of maternal mortality is highest for adolescent girls under 15 years old and complications in pregnancy and childbirth is a leading cause of death among adolescent girls in developing countries. (3,4)
The major complications that account for nearly 75% of all maternal deaths are (5):
· severe bleeding (mostly bleeding after childbirth)
· infections (usually after childbirth)
· high blood pressure during pregnancy (pre-eclampsia and eclampsia)
· complications from delivery
· unsafe abortion
The remainder are caused by or associated with diseases such as malaria, and AIDS during pregnancy.
A woman’s chance of dying or becoming disabled during pregnancy and childbirth is closely connected to her social and economic status, the norms and values of her culture, and the geographic remoteness of her home. Thus, the poorer and more marginalised a woman is, the greater her risk of death. In fact, maternal mortality rates reflect disparities between wealthy and poor countries more than any other measure of health. A woman’s lifetime risk of dying as a result of pregnancy or childbirth is 1 in 39 in Sub-Saharan Africa, as compared to 1 in 4,700 in industrialised countries. (6)
Why do women not get the care they need?
Poor women in remote areas are the least likely to receive adequate health care. The number of maternal deaths is highest in countries such as Sub-Saharan Africa and South Asia, where women are least likely to have skilled attendance at delivery, such as a midwife, doctor or other trained health professional. Other important factors include:
· Poverty
· Distance
· Lack of information/Education
· Inadequate services
· Cultural practices
What can be done?
· Investing in family planning and improved maternal healthcare
· Education
· More affordable and effective treatments
· Design training materials and guidelines for health workers
· Increasing research evidence
· Providing evidence-based clinical and programmatic guidance
· Addressing inequalities in access to and quality of reproductive, maternal, and newborn healthcare services
· Ensuring universal health coverage for comprehensive reproductive, maternal, and newborn healthcare
· Strengthening health systems to respond to the needs and priorities of women and girls
· Ensuring accountability in order to improve quality of care and equity
And the list goes on…
As women have gained access to family planning and skilled birth attendance with backup emergency obstetric care, the global mortality ratio fell by 44% between 1990 and 2015. The total number of maternal deaths around the world dropped from about 532,000 in 1990 to an estimated 303,000 in 2015, equating to an estimated global maternal death ratio of 216 maternal deaths per 100,000 live births in 2015, down from 385 in 1990. (2)
While there has been a decline in worldwide mortality rates, much more has to be done.
References
(1) Maternal Mortality. Geneva: World Health Organisation; December 2015. Available from: http://www.who.int/mediacentre/factsheets/fs348/en/
(2) Maternal Health. UNFPA; November 2015. Available from: http://www.unfpa.org/maternal-health
(3) Conde-Agudelo A, Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 2004, 192:342–349.
(4) Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet, 2009, 374:881–892.
(5) Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels JD, et al. Global Causes of Maternal Death: A WHO Systematic Analysis. Lancet Global Health. 2014;2(6): e323-e333.
(6) Rich Mother, Poor Mother: The Social Determinants Of Maternal Death And Disability. UNFPA; December 2012. Available from: http://www.unfpa.org/sites/default/files/resource-pdf/EN-SRH%20fact%20sheet-Poormother.pdf
Featured image: Adolescent Pregnancy. UNFPA. 2016.
