The challenge

The complications of pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries; more than 500,000 women die each year from maternal causes. And for every woman who dies, approximately 20 more suffer injuries, infection and disabilities in pregnancy or childbirth.

The most common fatal complication is post-partum haemorrhage. Sepsis, complications of unsafe abortion, prolonged or obstructed labour, and the hypertensive disorders of pregnancy, especially eclampsia, claim further lives.

These complications can occur at any time during pregnancy and childbirth without warning. They require prompt access to quality obstetric services equipped to provide lifesaving drugs, antibiotics and transfusions and to perform Caesarean sections and other surgical interventions.

The foundations for maternal risk are often laid in girlhood. Women whose growth has been stunted by chronic malnutrition are vulnerable to obstructed labour. Anaemia predisposes to haemorrhage and sepsis during delivery and has been implicated in at least 20 per cent of post-partum maternal deaths in Africa and Asia. The risk of childbirth is even greater for women who have undergone female genital mutilation, an estimated 2 million girls every year

The factors that cause maternal morbidity and death also affect the survival chances of the foetus and newborn, leading to an estimated 8 million infant deaths a year (over half of them foetal deaths) occurring just before or during delivery or in the first week of life.

Challenges to measuring maternal mortality

Maternal mortality is difficult and complex to monitor, particularly in settings where the levels of maternal deaths are highest. Information is required about deaths among women of reproductive age, their pregnancy status at or near the time of death and the medical cause of death - all of which can be difficult to measure accurately, particularly where vital registration systems are incomplete.

Maternal deaths are also relatively rare events, even in high-mortality areas, and are prone to measurement error. Therefore, UNICEF, the World Health Organization, the United Nations Population Fund, the United Nations Population Division and the World Bank have developed an approach to adjusting these data for underreporting and misclassification and producing model-based estimates for countries that lack reliable national-level data.

Trend analysis over time is problematic because of the large margins of uncertainty around the estimates. Nevertheless, a recent analysis of trends in maternal mortality based on 1990 and 2005 estimates shows that maternal mortality has decreased globally, although not at the rate needed to achieve MDG 5. The analysis finds, too, that during this period little progress was made in sub-Saharan Africa, the region with the highest levels of maternal mortality.

References

WHO, UNICEF, UNFPA and The World Bank. 2007.Maternal Mortality in 2005. Geneva.

Khan, Khalid S. et al. 2006. WHO Analysis of Causes of Maternal Deaths: A Systematic Review.” The Lancet, 367(9516): 1066-1074.

G. Schmid, N. Broutet, L. deBernis, S. Hawkes, Neonatal Survival Series. The Lancet, Volume 365, Issue 9474, Pages 1845-1845.

WHO, UNICEF and UNFPA, Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA. Geneva, 2004.

C. AbouZahr and T. Wardlaw, Maternal mortality at the end of the decade: What signs of progress? Bulletin of the World Health Organization, Vol. 79, No. 6, 2001 pp. 561-573.

WHO, UNICEF and UNFPA, Maternal Mortality in 1995: Estimates Developed by WHO and UNICEF. Geneva, 2001.

UNICEF, WHO and UNFPA, Guidelines for Monitoring the Availability and Use of Obstetric Services. October 1997.

WHO and UNICEF, The Sisterhood Method for Estimating Maternal Mortality. Guidance notes for potential users, 1997.

K. Hill, C. AbouZahr and T. Wardlaw, Estimates of Maternal Mortality for 1995, Bulletin of the World Health Organization, Vol. 79, No. 3, 2001, pp. 182-193).

WHO, UNICEF and UNFPA, Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA. Geneva, 2004.