Maternal Mortality

September 17, 2011

Deaths to women that are associated with pregnancy and childbirth fall under the category of maternal mortality. There are more than 500,000 maternal deaths each year in the world, of which almost all (98%) occur in developing nations, but even in the United States two or three women die each day of pregnancy-related causes. Regionally, the lifetime risk of maternal death is highest in Africa, where 1 in every 16 women is likely to be a victim. The risk of maternal death is 1 in 65 in Asia, 1 in 130 in Latin America, but is dramatically lower—1 in 1,800 women— in high-income nations. It is also estimated that for each woman who dies of complications of labor and delivery, at least 30 and possibly as many as 100 women survive childbirth but suffer from disease, disability, or other physical damage as a result of the complications of pregnancy.

An accurate assessment of maternal mortality rates is difficult to obtain, since the areas with the highest rates are often the same places that have the least accurate recordkeeping systems. In developing nations, people often die outside the health care system, and the cause of death is often not recorded even if a death occurs in a hospital. Furthermore, the number of deaths from unsafe (typically illegal) abortion is often underestimated, because the procedure may have been performed in secrecy. In both developing and developed countries, the recorded cause of death may be misclassified if the link to a pregnancy is not recognized.

There are numerous causes of maternal mortality, but 80% of deaths in the world are due to five primary complications. These include hemorrhage (25% of maternal deaths), sepsis (15%), toxemia (12%), unsafe abortion (13%), and obstructed labor (8%). The remaining 20% are often due to associated conditions, such as malaria, anemia, and HIV/AIDS. One in four maternal deaths occurs during childbirth, half occur within the first 24 hours after birth, and the remaining 25% occur in the days and weeks immediately following delivery. Complications that do not result in death can create lifelong conditions such as infertility, impaired mobility, severe anemia, chronic weakness, pelvic pain, uterine rupture, and fistula.

Worldwide, the availability of women’s health services makes a significant impact on levels of maternal mortality and morbidity. According to data from the United Nations Population Fund (UNFPA), approximately 15% of pregnant women experience some kind of complication, and about 5% of pregnant women require surgery, usually a cesarean section. Note that in the United States nearly one in four deliveries is by cesarean section, but that is a far higher percentage than would be required if it were used solely to save the life of the mother or baby. The World Health Organization estimates that no population requires more than 15% of births to be by cesarean section. It is estimated that about two thirds of infant deaths each year in the world are a result of poor maternal health and inadequate care during delivery. The UNFPA has recognized three keys to reducing maternal death and disability: (a) family planning to help ensure that every pregnancy is wanted; (b) each birth assisted by a skilled attendant; and (c) access to essential obstetric care so that in the case of complications a woman can reach a functioning health care facility in a timely manner.

Although the proximate cause of maternal death is typically an identifiable medical condition or complication, maternal deaths often represent the culmination of other factors in a woman’s situation. Maternal mortality and morbidity are a reflection, in particular, of the status of women in society. When women experience conditions of poverty, lack of education, early and too frequent childbearing, low status, and restricted choices, the likelihood of maternal mortality or morbidity is much higher. Social, cultural, and economic changes that improve the condition and status of women are a necessity to lower the risks of maternal mortality and morbidity throughout the world.

Although the risk of maternal death is considerably lower in industrialized nations than in other parts of the world, with an average of only 12 deaths out of every 100,000 live births, 2-3 women in the United States nonetheless die each day of pregnancy-related causes. Within the United States, the risk of maternal death varies greatly by race/ethnicity. In particular, black women are four times as likely as non-Hispanic whites to die of pregnancy-related complications, and Hispanic women are nearly twice as likely to die of these complications as are non-Hispanic whites. The risk has declined for all racial/ethnic groups over the past 50 years, but most of the improvements were prior to the 1980s. Since then there has been relatively little change in maternal mortality rates. Even so, it is estimated that over half of all maternal deaths could still be avoided through improved health care access, higher quality of care, and altering health and lifestyle habits.

In the United States, the leading causes of pregnancy-related deaths are hemorrhage, embolism, pregnancy-induced hypertension, infection, complications with anesthesia, and heart muscle disease. Although the risk of death is low in the United States, approximately 30% of pregnancies involve some kind of complication before, during, or even after delivery. The most common complications include miscarriage, ectopic pregnancy, excessive vomiting, diabetes, hemorrhage, infection, pregnancy-induced hypertension, premature labor, or the need for a cesarean delivery. Overall, childbirth is the most common reason for hospitalization of women in the United States, both for delivery and for treatment of complications.

In all cases, the repercussions of maternal mortality include children who must now survive without a mother, and the loss of an important member of a family and society.

SEE ALSO: Abortion, Access to health care, Morbidity, Mortality, Pregnancy

Suggested Reading

  • Sionke, J., & Donnay, F. (2001). Maternal mortality update 1998-1999: A report on UNFPA support for maternal mortality prevention. New York: United Nations Population Fund.
  • U.S. Centers for Disease Control. (2000). Safe motherhood: Preventing pregnancy-related illnesses and death.
  • World Health Organization. (2001). Maternal mortality in 1995: Estimates developed by WHO, UNICEF, and UNFPA. Geneva: Author.

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