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Maternal Health : Maternal health refers to the health of women during pregnancy, childbirth and the postnatal period.
Maternal Death : A maternal death is the death of a woman who dies from a pregnancy-related cause while pregnant or within 42 days of the conclution of pregnancy.
Maternal Mortality Ratio (MMR) : Maternal mortality ratio is the same as the above, but is expressed as a rate per 100,000 live births. It is a rate that can be used to compare the position between countries.
- Most maternal deaths are preventable with timely management by a skilled health professional.
- Around 295,000 died during and following pregnancy and childbirth in 2017 - about 810 a day.
- 94% of these occurred in low resource settings - most could have been prevented.
- In 2015, the world Maternal Mortality Ratio was 216/100,000.
- A Sustainable Development Goals is to reduce this to less than 70 deaths per 100 000 births by 2030
What has been happening?
There has been a fall in number of maternal deaths in the world. The exceptions to this are countries in Sub-Saharan Africa where the number has changed little since 1990. (Figure 1)
More than half of maternal deaths occur in fragile and humanitarian settings. 86% of the deaths occurred in Sub-Saharan Africa and Southern Asia in 2017. (Map 1)
There is a very big difference in the Maternal Mortality Ratio of high- and low-income countries with, for example, the maternal mortality ratio in the Central African Republic being 882/100,000 and 9/100,000 in the UK. (Figure 2).
Causes of maternal deaths
The following account for 75% of maternal deaths
- High Blood Pressure
- Delivery complications
- Unsafe abortion
- Barriers to receiving care
The main factors preventing women receiving or seeking care during pregnancy and childbirth
- Distance to facilities
- Lack of information
- Inadequate information
- Inadequate and poor quality services
- Cultural beliefs and practices
The Skilled Birth Attendants
Most maternal deaths are preventable with timely management by a skilled health professional.
In 2018, WHO updated its 2004 recommendations on Skilled Birth Attendants to see them as part of a wider system of maternal care. Skilled birth attendants are now seen as having the knowledge, skills and behaviours to be able to
- provide and promote evidence-based, human-rights-based, quality, socioculturally sensitive and dignified care to women and newborns
- facilitate physiological processes during labour and delivery to ensure a clean and positive childbirth experience
- identify and manage or refer women and/or newborns with complications
- perform (as part of a team) all signal functions of emergency maternal and newborn care (Basic Emergency Obstetric and Newborn Care – BEmONC; Comprehensive Emergency Obstetric and Newborn Care – CEmONC) to optimize their health and well-being
Skilled birth attendants also contribute to saving the lives of newborns.
As part of the effort to reduce maternal mortality under Sustainable Development Goal 3, measuring the proportion of births attended by skilled health personnel has been included as an indicator.
In most high income and upper middle income countries, more than 90% of all births benefit from the presence of a trained midwife, doctor or nurse. However, fewer than half of all births in several low income and lower-middle-income countries are assisted by such skilled health personnel. Map 2 shows the distribution across the world of births attended by skilled health staff.
WHO - Maternal Mortality
WHO – Maternal Mortality, Levels and trends 2000 – 2017
WHO - Global Causes of maternal death: a WHO systematic analysis (The Lancet Global Health)
WHO – The Global Strategy for Women’s and Children’s and Adolescents’ Health (2016 – 2030)
WHO – Maternal Health
WHO - Skilled Birth Attendants (Including Definition of skilled health personnel providing care during childbirth: the 2018 joint statement by WHO, UNFPA, UNICEF, ICM, ICN, FIGO and IPA)
WHO - Making Pregnancy Safer : The Critical role of the skilled attendant.
Ending preventable maternal mortality: phase II of a multi-step process to develop a monitoring framework, 2016 - 2030.