Pregnancy is meant to be a time of joy and anticipation. However, tragedy can strike, and maternal mortality remains a significant problem worldwide. About 810 women die every day from preventable causes related to pregnancy and childbirth according to the World Health Organization. The good news is that most of these deaths can be prevented with proper medical care and support.
What are the main causes of maternal mortality?
The leading causes of maternal death globally are:
- 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 contributing factors include anemia, malaria, heart disease and AIDS. Most complications occur during labor, delivery, or the 24 hours after. The health of the mother before pregnancy is also an important factor. Malnutrition and obesity can increase risks, as well as chronic conditions like diabetes, HIV, malaria and anemia.
Which women are most at risk?
Women in developing countries face the greatest risk of maternal mortality. Sub-Saharan Africa and Southern Asia account for over 80% of maternal deaths worldwide according to the WHO.
Women at higher risk include:
- Adolescent girls under 15 years old
- Women over age 35
- Those with more than 4 pregnancies
- Women with short intervals between pregnancies
- Those with chronic medical conditions
- Women with insufficient access to healthcare
Poor women in remote areas are among the most vulnerable. Access to skilled care during pregnancy and around the time of delivery is important to reduce risks.
Preventive Measures Before and During Pregnancy
Many maternal deaths can be prevented with proper healthcare and support before, during and after pregnancy. Some key interventions include:
Family planning and contraception
Allowing women to plan their pregnancies and space births safely reduces risks. Access to contraception gives women control over their reproductive health. Family planning improves health outcomes for mothers and babies. It can prevent closely spaced and ill-timed pregnancies and births, which contribute to maternal mortality. Contraception can also prevent unintended pregnancies, reducing unsafe abortions.
Good nutrition
Proper nutrition is vital before and during pregnancy. Taking supplements of iron and folic acid is recommended to prevent anemia. Adequate calorie intake and weight management are also important. Monitoring weight gain and consulting with a clinician helps identify problems early on. Diet and lifestyle changes may be needed for mothers who are underweight or overweight.
| Trimester | Recommended Weight Gain |
|---|---|
| First trimester | 2-5 lbs |
| Second trimester | 11-14 lbs |
| Third trimester | 6-11 lbs |
Take folic acid and iron supplements
Folic acid before and during early pregnancy helps prevent neural tube defects in babies. Taking iron supplements can prevent and treat iron-deficiency anemia, which increases maternal risks. Anemia contributes to 20% of all maternal deaths according to the WHO.
Educate mothers on warning signs
Community education helps women identify potential problems early. Danger signs to watch for include bleeding, swollen hands and face, headaches, vision changes and fever. Monitoring fetal movement is also important. Reporting warning signs quickly allows timely treatment.
Screen and treat infections
It’s important to test and treat any infections, including STDs, before trying to conceive. Untreated infections like HIV, malaria, syphilis and rubella can have serious consequences. Testing and treating urinary tract infections reduces risks as well.
Get regular prenatal care
Early and regular prenatal visits allow monitoring of maternal health and fetal development. Healthcare providers can catch potential problems through physical exams, lab tests and ultrasounds. They can also advise on proper nutrition, exercise, overall health and signs of concern. The WHO recommends at least 4 prenatal visits.
Prevent and treat chronic conditions
Optimizing health is vital before pregnancy. This includes properly managing chronic diseases like diabetes, hypertension, HIV, obesity and heart disease under a doctor’s care. Quitting smoking, alcohol and drugs also helps minimize risks.
Take measures to reduce mother-to-child infections
Some infections can pass from mother to baby during pregnancy or delivery. Steps like taking antiviral medication, getting vaccinated and having a C-section when appropriate can prevent transmission of certain infections.
Address socioeconomic factors
Social determinants of health have a significant impact. Improving women’s access to education, nutrition, healthcare, income opportunities and reproductive rights empowers mothers and leads to better outcomes.
Care During Labor and Delivery
Skilled medical care during labor and delivery is crucial for preventing complications and maternal mortality. Key interventions include:
Deliver at a health facility
Giving birth at a clinic or hospital reduces risks associated with childbirth by ensuring quick access to emergency care if needed. Skilled attendance by a healthcare professional is shown to decrease maternal mortality.
Address obstructed labor
Labor that stalls or does not progress normally can become life-threatening without medical intervention. Recognizing obstruction early and performing C-sections when appropriate improves outcomes.
Manage pre-eclampsia
Monitoring blood pressure and signs of pre-eclampsia allows treatment before severe complications occur. Pre-eclampsia can lead to eclampsia, organ damage, stroke and death. Administering magnesium sulfate for pre-eclampsia improves survival.
Prevent sepsis
Sepsis is a leading cause of maternal death globally. Practicing good hygiene and infection control during delivery is key. Identifying and treating postpartum infections promptly with antibiotics saves lives.
Treat postpartum hemorrhage
Severe bleeding after childbirth can occur rapidly. Having emergency protocols in place allows urgent treatment. Methods to stop bleeding include medications, uterine massage, surgical interventions, and interventions radiology. Blood transfusions may be life-saving as well.
Provide anesthesia for C-sections
Having skilled anesthetists available allows the safe use of regional anesthesia for C-sections. Spinal and epidural anesthesia have fewer risks than general anesthesia. They reduce complications and mortality when C-sections are needed.
Offer respectful care
All mothers have the right to be treated with dignity and respect during delivery. Preventing unnecessary procedures, accommodating cultural preferences and including mothers in decisions empowers women and leads to more positive childbirth experiences.
Postpartum Care
Ongoing care after childbirth is equally important for preventing complications and death. Priorities include:
Monitor for postpartum hemorrhage
Bleeding after delivery is the top cause of maternal mortality worldwide. Careful monitoring for excessive bleeding or dropping hematocrit allows rapid treatment with medications, IV fluids, blood transfusions or interventions to stop bleeding.
Provide prompt treatment for infections
Watching for signs of infection postpartum like fever, abdominal pain and foul-smelling discharge enables early diagnosis and treatment with antibiotics. Sepsis can develop rapidly after childbirth.
Address hypertensive disorders
Blood pressure must be carefully monitored after delivery, as high blood pressure can persist. Warning signs of preeclampsia like headaches and vision issues may still occur. Anti-hypertensives and magnesium sulfate can treat elevated pressures and prevent seizure, stroke and death.
Provide family planning and counseling
Discussing healthy timing between pregnancies reduces risks. Providing contraception options allows women greater control over spacing future births. Counseling mothers on danger signs equips them to monitor their health and seek help when needed.
Ensure postpartum follow-up care
At least one postpartum visit allows the healthcare team to tie up any loose ends and address any ongoing physical or mental health concerns. Exams, lab tests and referrals help identify and manage problems. Continued care improves outcomes extending beyond the postpartum period as well.
Offer mental health support
Physical recovery goes hand in hand with mental wellbeing. Screening mothers for postpartum depression and anxiety enables access to counseling services and treatment when appropriate. This leads to better health for mothers and babies alike.
Provide contraception options
Access to family planning empowers women to choose their family size and spacing between children. Voluntary contraception reduces the risk of closely spaced pregnancies and improves outcomes for mothers and children. Long-acting reversible contraceptives are very effective options.
Global Programs and Initiatives to Reduce Maternal Mortality
Many global efforts and partnerships focus on improving maternal health worldwide. These strategies and programs are making an impact.
The UN’s Global Strategy for Women’s and Children’s Health
This United Nations initiative launched in 2010 aims to save 16 million lives by 2025. It brings together governments, multilaterals, the private sector and civil society to improve access to quality healthcare for women, children and adolescents.
WHO Recommendations on Maternal Health
The World Health Organization provides evidence-based guidelines to establish standards of quality care for maternal health. Recommendations cover preconception, antenatal, childbirth, postpartum and postnatal care.
Ending Preventable Maternal Mortality by USAID
USAID’s vision is ending preventable maternal mortality within a generation. The agency focuses on improving access to voluntary family planning, strengthening health systems and collecting reliable data to inform priorities and track progress.
The Global Financing Facility
The GFF supports reproductive, maternal, newborn, child and adolescent health in developing countries. Through innovative financing aligned with national health plans, the GFF aims to expand access to quality care for women, children and adolescents.
Every Woman Every Child Global Strategy 2.0
This 2015 UN initiative has an ambitious target of less than 70 maternal deaths per 100,000 live births by 2030. It calls for facilitating universal access to sexual and reproductive care, and eliminating preventable deaths caused by complications of childbirth.
| Global Maternal Mortality Initiatives | Key Strategies |
|---|---|
| UN Global Strategy for Women’s and Children’s Health | Bring together partners to expand access to quality healthcare |
| WHO Maternal Health Recommendations | Establish standards of quality care for maternal health |
| USAID Ending Preventable Maternal Mortality | Increase access to voluntary family planning and strengthen health systems |
| Global Financing Facility | Innovative financing aligned with national health plans |
| Every Woman Every Child Global Strategy 2.0 | Universal access to sexual and reproductive care |
SDG 3 – Good Health and Wellbeing
The UN’s Sustainable Development Goals include targets to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. SDG 3 also calls for ensuring universal access to sexual and reproductive healthcare services by 2030.
Country Success Stories
Many countries have made impressive strides in reducing maternal mortality over the past 25 years:
Rwanda
Rwanda has cut its maternal mortality rate by more than 80% since 2000 thanks to strong family planning programs, health system strengthening and shifting childbirth into facilities. Nearly all Rwandan women now deliver with a skilled provider.
Ethiopia
Ethiopia reduced its maternal mortality rate by over 70% between 2000 and 2018 through health workforce expansion, improved access to contraception and better emergency obstetric care.
Malaysia
Malaysia decreased its maternal mortality rate more than 90% between 1990 and 2015 by improving access to skilled birth attendants, upgrading emergency obstetric care and increasing facility-based deliveries.
Iran
With an integrated primary healthcare system extending into rural regions, Iran cut maternal deaths by over 80% from 1989 to 2015, despite soaring birth rates. Midwives play a key role.
Egypt
Egypt more than halved its maternal mortality rate between 1992 and 2014 by improving emergency obstetric care and access to family planning. Increased education for women also contributed.
Conclusion
Preventing maternal deaths requires strengthening healthcare systems, expanding access to voluntary family planning, and providing skilled care during pregnancy, childbirth and postpartum. Global partnerships, financing and initiatives like the SDGs are driving progress, but more work remains to achieve health and equity targets for mothers worldwide. Successful countries demonstrate that dramatic reductions in maternal mortality are achievable. Continued effort and investment in proven interventions can help save precious lives and ensure that pregnancy and childbirth are safe for all women throughout the world.
