Maternal & Newborn Health

Most causes of maternal and newborn mortality are preventable

 

Key Messages	Overview	Facts & Statistics	Stories from the Field

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Key Messages

• Countries with the highest MMR^** are countries that are undergoing or have undergone
  conflict. The top ten countries are: Afghanistan (1400), Chad (1200), Somalia (1200), Guinea-Bissau (1000), Liberia (990), Burundi (970), Sierra Leone (970), Nigeria (840), Mali (830) and Niger (820).¹
• The ten countries with the highest maternal deaths^* are India (63,000), Nigeria (50,000), the Democratic Republic of the Congo (19 000), Afghanistan (18,000), Ethiopia (14,000), Pakistan (14,000), the United Republic of Tanzania (14,000), Bangladesh (12,000), Indonesia (10,000), and the Sudan (9,700). Together, all ten countries comprise 62 percent of the total maternal mortality in the world and have at one point been affected by conflict.²
  
• Nine of the ten countries are experiencing or emerging from conflict. Tanzania, a relatively
  peaceful country hosts more than a half-million refugees, more than any other African country.³
• All of the countries have populations of refugees and/or IDPs that live within their borders. Additionally, the majority of listed countries are experiencing on-going conflict or are emerging from conflict.⁴
• There are more than 40 million refugees and internally displaced persons (IDPs) fleeing conflict and persecution in the world today. Millions more are affected by natural disasters.⁵
• Out of every 100,000 people:
  • 25,000 will be women of reproductive age.⁶
  • At least 3,000 women will be pregnant at a given time.⁷
  • More then 330 babies will be born every month.⁸
  • At least 66 pregnancies will end in miscarriage or unsafe abortion every month.⁹
  • At least 50 pregnancies will experience complications every month.¹⁰
• Worldwide:
  • 41 women will die every hour from pregnancy-related causes and 99% of these deaths occur in developing countries.¹¹
  • 1 woman will die every 1.46 minutes from pregnancy-related causes and 99% of these deaths occur in developing countries.¹²
  • 1 woman will die every 88 seconds from pregnancy-related causes and 99% of these deaths occur in developing countries.¹³
• Girls aged 15-19 are twice as likely to die in childbirth as women in their twenties.¹⁴
• It is a human rights violation not to provide satisfactory maternal health care.
• A woman faces the risk of death or disability every time she becomes pregnant due to pregnancy-related complications.  However, if treated appropriately and in a timely manner, almost all women who develop pregnancy-related complications can be saved from death and disability.
• The three-delay model¹⁵ provides a framework within which to understand three common causes that can lead to maternal mortality as well as key interventions to address these causes:
  • First Delay: the woman is often not recognized as needing emergency obstetric care (EmOC).
    • Interventions:
  • Improve awareness of obstetric danger signs among pregnant women and  in the community
  •  Involve traditional birth attendants (TBAs) in early recognition and timely referral of women
  • Second Delay:  the woman arrives to the referral facility late
  • Interventions:
    • Improve referral system by building communication capacity and a reliable transport mechanism
    • Implement community finance and transport schemes
• Third Delay:  the facility is not staffed and equipped to provide EmOC services or the woman is not able to access the services upon arrival
  • Interventions:
    • Improve coverage of EmOC to include the minimum requirement of four basic and one comprehensive EmOC facility for every 500,000 people
    • Improve quality of EmOC, clients’ satisfaction and 24/7 coverage
    • Improve utilization of EmOC services by reducing barriers and ensuring equitable access.
• A 2011 UNFPA report on midwifery in 58 developing countries calculated there are about 536,000 health workers with essential midwifery competencies in these countries.  The report also estimated that in most of the countries the midwives to births ratio is lower than the target ratio of 6 midwives per 1000 births.  Chad, Sierra Leone, Haiti, and Sudan have the lowest ratios, with less than 1 midwife per 1000 births.¹⁶
• In UNFPA’s 2011 global midwifery report, over two thirds of the countries reporting on emergency obstetric care were providing EmONC in less than 50 percent of their maternity facilities.¹⁷
• Crowe, et al.’s analysis in 2012 estimated there will be 130 to 180 million births without a skilled birth attendant in South Asia and Sub-Saharan Africa between 2011 and 2015, and 90 percent of these births will take place in rural areas. ¹⁸ 
• An extensive study published in 2011 by the WHO, Aga Khan University, and the Partnership for Maternal, Newborn & Child Health (PMNCH), details the 56 essential interventions for maternal and newborn health.  The study outlines the level of medical training and type of setting best suited to each intervention, as well as additional resources.¹⁹  
• In a report published by Maskey et. al., field testing of the motherhood method in a district with a population of about 600,000 demonstrated that maternal mortality can be directly measured if the BCG (a vaccine to immunize against Tuberculosis) and TT (Tetanus Toxoid) vaccination registers are in place and local health workers or volunteers and the mothers themselves in the wards are properly mobilized and supervised for data collection.²⁰
• More than 80 percent of maternal deaths are caused by hemorrhage, sepsis, unsafe abortion, obstructed labor and hypertensive diseases of pregnancy. The majority of these deaths could be prevented with access to quality reproductive health services, equipment, supplies and skilled healthcare workers.²¹
• All pregnant women should have access to quality services before, during and after pregnancy and childbirth. These services must include facilities that offer EmOC for women who develop complications.
• High mother and infant death rates are not explained by poverty alone: political will and effective strategies can save the lives of mothers and their newborns despite limited financial resources, as is evidenced in countries like Indonesia, Vietnam, Eritrea and Nicaragua.²²
• Reducing maternal mortality requires a sustained commitment and the involvement of a range of partners. Programs should be developed, evaluated and reviewed with the appropriate involvement of community members, health care providers, traditional birth attendants and community leaders.
• To prevent excess maternal and newborn mortality and morbidity EmOC services must be available and supported by a 24/7 referral system and clean delivery kits should be provided to birth attendants and visibly pregnant women.
• After a crisis stabilizes all pregnant women should be recorded for targeted individual care as well as help to ensure that adequate supplies and materials are available.
• According to a study conducted in India by Sweet et. al., increasing access to family planning was the most effective individual intervention to reduce pregnancy-related mortality.²³
• If contraception were accessible and used consistently and correctly by women wanting to avoid pregnancy, maternal deaths would decline by an estimated 25–35%.²⁴
• Data demonstrate that adolescent girls living in rural areas who are not in school and who are often married as children are vulnerable to maternal mortality and morbidity, unwanted pregnancies, unsafe abortion, HIV infection, and sexual violence and abuse.²⁵

 

 

^* Maternal deaths are reported through a series of different collection tools and mechanisms.
^**Maternal mortality ratios (MMR) are the number of maternal deaths during a given time period per 100,000 live births during the same time-period.

 

 

References
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