Maternal & Newborn Care

Key Messages

• 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.
• Not providing appropriate and adequate maternal care is a human rights violation.
• All pregnant women should have access to quality services before, during and after pregnancy and childbirth. These services must include facilities that offer emergency obstetric care (EmOC) for women who develop complications. At the same time, women must always be able to make free and informed decisions about their health.
• 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.[1]
• Reducing maternal mortality requires a sustained, long-term commitment and the involvement of a range of partners. Programs should be developed, evaluated and and reviewed with the involvement of clients, health care providers, traditional birth attendants and community leaders.
• When working with displaced populations, international agencies must support health care facilities so that basic and comprehensive EmOC services are provided in addition to establishing a functional hospital referral system in the community for obstetric emergencies.
• Nine-eight percent of maternal deaths occur in developing countries, with the highest rates in Africa and South Asia.[2]
• The most effective interventions to prevent high-risk pregnancies include female education, improved nutrition and family planning.[3]
• Half of pregnant women in Africa deliver without the presence of a trained health worker.[4]
• Physicians for Human Rights has begun to use maternal mortality as an indicator for human rights abuse.[5]

Overview

Maternal/Newborn Care is a woman’s ability to have a safe and healthy pregnancy, delivery and post- delivery period. Complications associated with pregnancy and childbirth are the leading cause of death and disability among women of reproductive age in developing countries. According to the World Health Organization (WHO), a maternal death is the death of a woman while pregnant or within 42 days of the termination of her pregnancy from any cause related to or aggravated by the pregnancy or its management. The leading causes of maternal death are due to five direct causes: hemorrhage, sepsis, complications resulting from unsafe abortion, prolonged or obstructed labor and hypertensive disorders.[6]

Maternal deaths are caused by three major delays:

1) A delay in the decision to seek care;

2) A delay in transportation to a health care facility; and

3) A delay in receiving appropriate care at the health care facility.

Millions of women also suffer infections and debilitating injuries from complications of pregnancy and childbirth. An increase in vaginal fistula, where tears in the tissue of the vagina, bladder and rectum leave women unable to control their bodily functions, have correlated to early marriage, harmful traditional practices such as female genital mutilation, and exceedingly violent rapes of women and girls in conflict-affected areas. Affected women and girls are often ostracized by their communities and may be divorced or abandoned. When fistula is left untreated, there is little possibility of carrying another pregnancy to term. Often the desperate circumstances in which displaced women and girls flee conflict, places them at exceptional risk of pregnancy-related death, illness and disability. Health care services and resources that women and girls may have had before their displacement are usually no longer available to them. Childbirth may take place in a ditch alongside the road, in the forest or in a makeshift shelter.

Services to prevent maternal death and disabilities include:

• Reproductive health care within a human rights context;
• Care by skilled attendants before, during and after childbirth;
• EmOC for life-threatening obstetric complications;
• Prevention and management of complications due to unsafe abortion;
• Family planning to enable women to plan their pregnancies and prevent unwanted pregnancies;
• Health education and services for adolescents;
• Community education for women, their families and decision-makers; and
• Monitoring and evaluation including the UN Process Indicators of Emergency Obstetric Services.

Facts

Global Statistics

• Every minute one woman dies from a pregnancy-related complication.[7]
• Every day 1,440 women die from complications of pregnancy and childbirth.[8]
• Every year approximately 529,000 women die from maternal causes.[9]
• Every year 8 million babies are stillborn or die before they reach the age of one month.[10]
• For every woman who dies, approximately 20 more suffer from injuries, infection and disabilities in pregnancy and childbirth.[11]
• A million or more children are left motherless each year as a result of maternal mortality. These children are three to 10 times more likely to die within two years than children who live with both parents.[12]
• One-quarter of women in developing countries, approximately 300 million women today, suffer problems in pregnancy and delivery.[13]
• UNICEF reports that more girls and women from developing countries die from childbirth complications than from any other cause. Of the 1,400 women and girls who die each day from delivery complications, 99 percent of them are in less developed countries.[14]
• Postpartum hemorrhage has resulted in at least 25 percent of the 500,000 maternal deaths globally. In some countries, this number reaches up to 60 percent.[15]
• A study of 49 countries found that access to reproductive health services is one of two key indicators for maternal mortality in developing countries.[16]
• The lifetime risk of maternal death is highest in sub-Saharan Africa, where a woman’s risk of dying from maternal causes is as high as 1 in 16, compared with 1 in 2,800 in industrialized countries. African women’s risk of dying in childbirth is 175 times greater than for women in developed regions.[17]
• UNICEF states that while sub-Saharan Africa has only 12 percent of the world’s population, the region has 42 percent of all deaths under age five.[18]
• Between 1995 and 2000, the world’s 1.3 billion women of child-bearing age experienced a total of more than 1.2 billion pregnancies. Of these, well over one quarter were unintended.[19]
• Where contraception is inaccessible or of poor quality, many women will seek to terminate unintended pregnancies. Estimates based on figures for the year 2000 from the World Health Organization indicate that 19 million unsafe abortions take place each year. That is, approximately one in ten pregnancies ends in an unsafe abortion.  Almost all unsafe abortions take place in developing countries.[20]
• Worldwide, unsafe abortion is responsible for approximately 70,000 pregnancy-related deaths each year.[21]
• While unsafe abortion is completely preventable, it continues to be a major cause of maternal mortality and morbidity in the developing world. The World Health Organization reports that 1 in 270 unsafe abortions will lead to fatal complications, with all deaths occurring in developing countries. Nearly half of all deaths from unsafe abortion take place in sub-Saharan Africa, where unsafe abortion constitutes between 10 to 50 percent of all maternal deaths.[22]

Refugee/Internally Displaced/Conflict-affected Statistics

• A 2002 report indicates that 33 out of 50 countries affected by conflict rank lowest in mother and children's indicators of well-being, including health, contraceptive use and infant mortality.[23]
• A study in Uganda revealed that the risk of becoming infected with HIV is higher when women are pregnant.[24]
• Approximately 25 percent of women of reproductive age in any displaced population will be pregnant at one time. As with all women, 15 percent of them will suffer from unforeseen complications of pregnancy and childbirth.[25]
• A UNICEF survey found that girls in war-torn southern Sudan are more likely to die in pregnancy and childbirth than finish primary school.[26]
• According to a 2003 survey by the UNFPA, the number of Iraqi women who die in pregnancy or in childbirth has tripled since 1990. In 2003, before the start of the second Gulf War, many pregnant Iraqi women demanded to have caesarean sections rather than risk delivering their infants during war, even though some were well short of their due date, increasing the risk to mother and child.[27]
• Since the beginning of the second Intifada in 2000, over 50 percent of Palestinian mothers in the West Bank give birth at home instead of risking a ride to the hospital. Fifty-two Palestinian women have given birth at West Bank checkpoints and 29 (over half) of those newborn babies have died since the uprising began.[28]
• Reproductive-related causes were the leading cause of mortality (at 22 percent) among Afghan refugee women of reproductive age in Pakistan.[29]
• The largest maternal mortality survey ever conducted in Afghanistan found that pregnancy and childbirth were the leading cause of death among Afghan women of childbearing age. The maternal mortality rate in Afghanistan is the highest in the world and a woman dies of pregnancy-related causes every 27 minutes. In addition, 92 percent of Afghan women give birth without the assistance of a trained midwife, and 98 percent of women do not use modern contraception.[30]
• Maternal death rates in war-torn Southern Sudan are as high as 865 per 100,000 births, compared to 550 per 100,000 in the rest of the country.[31]
• Sudanese women fleeing conflict have to give birth without even the barest essentials for clean delivery, such as a fresh razor blade and soap. This exposed many women to fatal infections. One in nine of these women were estimated to die in pregnancy or childbirth in 2003.[32]
• Among displaced and non-displaced women in Bosnia and Herzegovina, the perinatal mortality rate rose from 15.3 per 1,000 live births before the war to 38.6 per 1,000 after the war.[33]
• A study of poor pregnancy outcomes among Burundian refugees in Tanzania found that infant and maternal deaths accounted for 15 percent of all deaths during the study period.[34]
• A 2004 nationwide mortality survey in the Democratic Republic of the Congo found that maternal deaths were much more common in the conflict-riddled eastern provinces, with 1,174 maternal deaths per 100,000 live births, than in the west, with 811 deaths per 100,000 live births.[35]
• In Uganda, civil unrest in the northern region has resulted in an abortion rate of 70 per 1,000, almost a quarter higher than the national average 54 per 1,000. Even the national average indicates that half of all Ugandan women will require treatment for complications related to abortion in their lifetime.[36]

Case Studies

Liberia success story
Mamie Guankanue, a 25-year-old woman from Beatuo village in Liberia, went into premature labor due to acute febrile condition. She gave birth to a premature baby, attended by a trained traditional midwife. After delivery, the placenta was retained. Two days later, Mamie was transported to Gblarlay Clinic, a medical clinic 13 km away set up by the International Rescue Committee. Upon arrival at the clinic, the midwife managed to remove the retained placenta. “I could have been a dead person by now if IRC have not brought the emergency obstetric care program to us. Where I was, I never knew that I could be alive,” said Mamie. After counseling from clinic workers, Mamie is now knowledgeable in taking care of her premature baby. “Thanks to Gblarlay Clinic for saving my life, to the people who thought of us and put this life-saving program together. I will forever remember Gblarlay Clinic and I will advise all friends that whenever they get pregnant, they should seek medical care at the clinic,” said Mamie as she took leave of the clinic and traveled back home with her baby.

Dire consequences of unsafe abortion
Wah Wah is a 38-year-old Burmese woman working as a gardener in Thailand. She has five children ages 7 to 20. After the birth of her fifth child, Wah Wah started using an injectable family planning method for contraception. After five years, she stopped using this method because she did not think that she could get pregnant because she had used the injectable for so long and because she was too old. When Wah Wah did not get her period for two months, she went to the traditional birth attendant to find out if she was pregnant. The traditional birth attendant gave her a vaginal exam and inserted a stick into her vagina and uterus “to make her period come.” Two weeks later she started to bleed, and after two or three days of bleeding she came to a local NGO health clinic with a fever. The clinic staff found the stick, which had induced an abortion at three months. Wah Wah had septicemia, an overwhelming infection of the bloodstream that affects all of the internal organs, for which she was given antibiotics. She was counseled regarding the option of having a tubal ligation in order to avoid future pregnancy. Wah Wah said she would discuss this option with her husband. She still suffers from pelvic inflammatory disease, a painful, chronic condition.

Resources

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Updated September 2006