Maternal mortality

"Labour" – the act of giving birth – is the most dangerous labour in the world. Outside of a small number of privileged and/or conscientious countries that have succeeded in reducing maternal mortality to close to zero, each pregnancy and birth is a risky and potentially fatal experience for hundreds of millions of women worldwide.

The term maternal mortality is used to refer to all deaths of women ascribed to childbirth and puerperium, the few weeks immediately after birth. Postpartum haemorrhage, often with anaemia as an underlying or associated cause, sepsis and toxaemia are the most frequent causes of maternal deaths and are directly related to the absence or inadequacy of prenatal and delivery care. Pregnancies that happen before a woman is biologically ready for childbearing; pregnancies which occur towards the end of her reproductive span and pregnancies which follow many previous birth carry additional biological and behavioural risks independently of a woman's setting or life circumstances.

Because childbearing is spread over more years in developing than in developed countries, women in developing countries not only undergo a higher risk per pregnancy but they are at risk over a longer period of their lives. Maternal deaths may severely affect infants and young children, who often die soon after the passing of their mothers. Some children suffer impaired health or development prospects.

For every woman who dies from causes related to pregnancy or birth, approximately 30 more incur injuries, infections and disabilities which are usually untreated and unspoken of, and which are often humiliating and painful, debilitating and lifelong.

Nearly 600,000 women a year die as the result of pregnancy or pregnancy related causes. 99% of these deaths occur in the developing world. An estimated 7 million peri-natal deaths (deaths of babies) are associated with maternal health problems. Maternal mortality rates represent the greatest disparity between developing and developed countries of any human development indicator. The risk of a woman dying in childbirth is 150 times greater in a developing country than in the industrialized world. A woman in Ethiopia has a one-in-ten chance of dying of childbearing-related problems, while a Spanish woman has one chance in 9,000; a woman in the USA has one chance in 3,500 because a greater number are teenagers than in other developed countries. In a number of developing countries, maternal mortality rates in excess of 500 per 100,000 live births are by no means exceptional, and rates of over 1000 per 100,000 have been reported in parts of Africa. It has been estimated that, in the areas with the highest maternal mortality (such as most of Africa and west, south, and east Asia) about half a million women die from maternal causes every year, leaving behind at least one million motherless children. In Latin America, the maternal mortality rates are much lower, but several studies have shown serious underreporting of maternal causes of death; in some countries up to half of such deaths were not reported accurately.

The high mortality of women in developing countries in their middle years is a cause for grave concern. Age-specific death rates for women rise sharply between the ages of 20-30 in many countries, where women often have less chance than men of surviving the years between 15 and 45. In a number of countries in Asia, life expectancy at birth is actually lower for women than for men. Despite the known underrecording, maternal causes are still among the leading causes of death for women in the child-bearing ages. In almost all developing countries, deaths from maternal causes are among the five leading causes of death for women aged 15-44; in one-third of these countries they come first or second.

A 1993 World Bank estimate shows that in some African countries, less than 10% of women needing family planning and maternity care services actually receive it. In a survey in rural areas in Bangladesh, maternal mortality was found to be 570 per 100,000 live births, the mortality rate for the youngest group of mothers being as high as 1,770 per 100,000. Maternal mortality accounted for 57% of deaths of women aged 15-19 years in the area and 43% of deaths of women aged 20-29. In Afghanistan, maternal mortality has been estimated to be around 700 per 100,000 live births. Variations within countries are considerable. In Afghanistan, for example, the urban rate was almost half the figure quoted above, and in Malaysia the highest rate for a district was 18 times the lowest rate.