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Improving Global Maternal Health: Challenges and Opportunities
Key Points
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Every day, 800 women die as a result of pregnancy or childbirth, and an additional 16,000 develop severe and long-lasting complications.
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Every day, 8000 newborn infants die and 7000 are stillborn, and more than half of these deaths are from maternal complications.
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Adolescent pregnancies account for 11% of all births worldwide, and these young girls and their infants are at far higher risk of death and complications than other mothers.
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Of all the maternal and neonatal deaths worldwide, 99% take place in developing countries.
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The leading obstetric causes of maternal death in developing countries are hemorrhage, puerperal sepsis, preeclampsia, unsafe abortion, obstructed labor, and embolism. HIV causes a growing number of deaths in countries where it is endemic.
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If all pregnant women and their babies could access the maternity care recommended by the WHO, the annual number of maternal deaths would fall by two- thirds—from 290,000 to 96,000—and newborn deaths would fall by more than three- quarters to 660,000 each year.
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If all women had control over their fertility and could access effective contraception, unintended pregnancies would drop by 70%, and unsafe abortions would drop by 74%.
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Apart from a lack of skilled health care and other resources, the quality of the care provided also varies widely. The clinical guidelines and protocols set forth by the WHO and professional organizations need to be urgently implemented, and their uptake audited, in developed as well as in developing countries.
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Safe motherhood for all women is enshrined as a basic human right by the UN, yet many societies have yet to recognize and address this, and they fail to provide the necessary resources to provide adequate reproductive health, maternity, and newborn care or to enact and enforce laws to support equality for women in all aspects of their life, which includes abolition of child marriage and other harmful traditional practices.
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A woman’s life is always worth saving.
Maternal and Reproductive Health
Maternal Health and The Burden of Death and Disability
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Maternal deaths are merely the tip of the iceberg. Globally it is estimated that over 300 million women are living with short- or long-term pregnancy-related complications with around 20 million new cases occurring each year.
A Place Between Life and Death
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Overall, this burden of maternal and neonatal mortality, including stillbirths, accounts for around 15,800 deaths each day, or 10 lives lost every minute.
Where Mothers Die
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The latest United Nations (UN) estimates for 2013 are that the overall global maternal mortality rate (MMR) is 210 deaths per 100,000 live births, with an even higher figure (230) for developing regions (low- and middle-income countries) compared with 12 for developed regions.
Adolescent Girls and Lifetime Risk of Maternal Death
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In developing countries, a 15-year-old girl faces a 1:160 risk of dying from a pregnancy-related complication during her lifetime, and this rises to an average risk of 1:38 for those who live in sub-Saharan Africa.
United States
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The WHO estimated the overall MMR for the United States to be 28 per 100,000 live births in 2013, which is threefold greater than in Western Europe and Australasia.
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The United States is one of the few countries whose MMR has increased rather than decreased in recent years. This may be due to a steady rise in the number of women with advanced maternal age, chronic medical conditions, and obesity coupled with an increasing number of medical interventions, not all of which may be necessary.
Mothers Who Survive: Severe Maternal Morbidity
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It is estimated that 1.1 million of the annual total of 136 million births are complicated by a severe maternal “near-miss” event, after which the mother survived either by chance or following high-quality medical care. Direct maternal deaths are those resulting from obstetric complications of the pregnancy state (pregnancy, labor and the puerperium); from interventions, omissions, incorrect treatment; or from a chain of events resulting from any of the above. Indirect obstetric deaths are those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy.
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Coincidental maternal deaths are those from unrelated causes that happen to occur in pregnancy or the puerperium.
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Late maternal deaths are those of a woman from direct or indirect obstetric causes, more than 42 days, but less than 1 year after termination of pregnancy.
Infants Who Die
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Around half of the annual 2.6 million stillbirths and 2.9 million deaths in the neonatal period, the first month of life, occur as a result of maternal complications during pregnancy or delivery.
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Most neonatal deaths (73%) occur during the first week of life, with around 36% in the first 24 hours. The major causes are complications that arise from preterm birth (36%), intrapartum asphyxia (23%), and neonatal infections such as sepsis, meningitis, and pneumonia, which together contribute 23%.
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Labor and the 24 hours surrounding birth are the riskiest times for mother and baby, with 46% of maternal and 40% of neonatal deaths and stillbirths occurring during this period.
Why Mothers Die
Clinical Causes
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Deaths from illnesses related to HIV and AIDS, regarded as indirect deaths, make a major contribution to maternal mortality globally and in some sub-Saharan countries cause more than half of all indirect deaths.
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