Every year 295,000 women die from pregnancy-related causes. 99% of these deaths occur in the developing world. Why is this happening?
According to the World Health Organization:
The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia.
Significant strides have been made in the last decade, and maternal mortality rates have fallen by more than 30 percent. Still, every day almost 808 women or girls die from something that is mostly preventable.
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.
Women in developing countries have, on average, many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is higher. A woman’s lifetime risk of maternal death – the probability that a 15 year old woman will eventually die from a maternal cause – is 1 in 4,900 in developed countries, versus 1 in 180 in developing countries. In countries designated as fragile states, the risk is 1 in 54; showing the consequences from breakdowns in health systems.
Mothers in developing nations are dying due to one of three deadly delays. The first delay is in the decision to seek care, the second is the delay in reaching the appropriate medical facilities and the final delay in care is at the health care institution itself.
Decision To Seek Care
The first deadly delay, in seeking care, is influenced by many things. A woman may not be able to seek care on her own, but may have to wait for her husband or mother-in-law to allow her to do so. The woman and her family may not recognize a serious problem until it is too late. There may also be cultural expectations and prejudices. For example, in some cultures, women who don’t deliver naturally are seen as failures.
Reaching Appropriate Medical Facilities
The second deadly delay, to reach the appropriate facility in time, results from a lack of transportation. There may be no vehicle available, or roads may be washed out by strong rains.
The Health Care System
The final deadly delay in care, at the health centre, is often a result of no medical staff being available. The centre’s pharmacy may be empty or there may be no blood ready for an emergency transfusion. Any of these situations can also cause a mother’s death.
How are Mothers Dying?
In the developing world, the largest cause of mothers dying from pregnancy complications is severe bleeding. One in four deaths result from hemorrhaging. Other causes include infection (15%) and high blood pressure in pregnancy (12%). Most of these causes are preventable.
One in four women who die during childbirth simply bleed to death. A medicine, oxytocin, costing less than 99 cents a vial, could prevent that.
According to the World Health Organization, nearly 75% of all maternal deaths are caused by:
- severe bleeding (mostly bleeding after childbirth)
- infections (usually after childbirth)
- high blood pressure during pregnancy (pre-eclampsia and eclampsia)
- complications from delivery
- unsafe abortion
Other factors that prevent women from receiving or seeking care during pregnancy and childbirth are:
- lack of information
- inadequate services
- cultural practices
The Need for Skilled Attendants
At the heart of the issue is that about half of all women in developing countries don’t have a skilled birth attendant at their delivery. A skilled birth attendant, whether it is a doctor, nurse or midwife, can manage normal deliveries and identify the onset of complications. Due to distance, poverty and other social barriers, many women still give birth with untrained birth attendants, a family member or even on their own. The shortages of skilled birth attendants in low income countries and lack of emergency obstetric care adds to the problem.
Percentage of Deliveries with a Skilled Attendant
World Health Organization, 2012
- Global average: 68%
- Africa: less than 50%
- North America: 99.5%