Every year 287 000 women die from difficulties in pregnancy and childbirth, while millions more suffer from post partum injuries.
Developing countries account for 99% of all maternal deaths, with nearly three fifths of the maternal deaths occurring in sub-Saharan Africa alone.
The cumulative lifetime risk of maternal death is as high as 1 in 16 pregnancies in some countries in sub-Saharan Africa, compared to 1 in 2800 in most developed countries.
Direct causes of maternal death
While maternal mortality is related to a variety of health, social and economic factors, the majority of deaths are directly caused by a limited number of complications such as haemorrhage, hypertensive disorders, sepsis, and obstructed labour which require access to emergency obstetric care.
Adapted from WHO (2005)
Maternal and neonatal deaths are clustered around the delivery and the post partum period, with mortality risks strongly associated with the "three delays" in receiving skilled care at the time of an obstetric emergency - e.g. delays in the decision to seek care, in reaching health facility, and receiving quality care on arrival. A recent multi-country study has shown that these delays are often attributed to financial barriers, transportation challenges and distance to appropriate facilities.
Access to a medically-assisted delivery
Ensuring that mothers have access to a skilled attendant during labour can dramatically reduce the risk of death for the mother and newborn child. In almost all countries where health professionals attend more than 80 per cent of deliveries, maternal mortality ratios are below 200 per 100,000 deliveries.
In rural areas where doctors and nurses are scarce, women often give birth at home without the assistance of a skilled health worker with the medical skills or equipment to provide life-saving interventions in the case of emergencies.
Approximately 15 per cent of all pregnancies result in complications and require emergency medical intervention, including Caesarean sections to relieve obstructed labour. However, Caesarean sections represent less than 1 per cent of all births in Africa, due to a lack of access to medically assisted deliveries or to transportation for referral to a health facility.
The importance of antenatal care during pregnancy
During the 1990s, there were noticeable increases in the use of antenatal care in some developing countries, particularly Asia. However, in sub-Saharan Africa, antenatal care use increased only marginally over the decade. In Ethiopia for example, only 27% of women receive 1 antenatal visit and 10% receive 4 visits.
Improving the coverage, frequency and quality of antenatal care is an essential step to improving maternal and neonatal health indicators because many effective interventions can be provided during pregnancy. One of the most cost-effective and simple antenatal interventions is immunisation against tetanus. In areas where malaria is endemic, intermittent presumptive treatment of malaria can reduce incidence of low birth weight, stillbirths, and neonatal and maternal mortality. Rubella vaccination reduces stillbirths and avoids congenital rubella syndrome. Diagnosis and treatment of reproductive tract infections reduce the risk of premature labour, as well as the direct perinatal deaths caused by syphilis. The antenatal period also presents an important opportunity for identifying threats to the unborn baby’s health, as well as for counselling on nutrition, birth preparedness, parenting skills and family planning options after the birth.
Raising awareness about improved maternal health
Raising awareness in local communities about the importance of promoting good reproductive health practices, including access to family planning, antenatal care, cost-effective interventions for pregnant women, and skilled attendants during delivery can dramatically improve maternal health indicators.