Maternal Mortality: Definition, Causes, Risk Factors, Challenges, Preventive Measures

Table of Contents

What is Maternal Mortality?

According to World Health Organization (WHO), Maternal Mortality is defined as ‘the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.’
In other words, it refers to the death of a women due to pregnancy or child birth related complications.

Key Facts of Maternal Mortality

Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth.
94% of all maternal deaths occur in low and lower middle-income countries.
Women living in rural areas and among poorer communities have higher maternal mortality.
Young adolescents face a higher risk of complications and death as a result of pregnancy than other women.
Women and newborn babies’ lives can be saved through skilled care before, during and after childbirth.
Between 1990 and 2015, maternal mortality worldwide dropped by about 44%.
Between 2016 and 2030, reducing the global maternal mortality ratio to less than 70 per 100 000 live births is the target in Sustainable Development Goals.
Most of the maternal deaths are preventable through proper health care solutions.
Severe bleeding after childbirth can kill a healthy woman within a short span of couple of hours, if left unattended.
Administering Magnesium Sulphate (MgSo4) during pre-eclampsia can reduce the risk of developing eclampsia and prevents death of the pregnant women.
Proper access to contraception, safe abortion services and quality post-abortion care can reduce the risk of maternal mortality.

Causes of Maternal Mortality

1. Direct causes

Direct causes of maternal mortality include those resulting from obstetric complications of pregnant state (pregnancy, delivery and post-partum)
It also includes the maternal death from interventions, omissions, incorrect emission, treatment or from a chain of events resulting from any of the above
For example: deaths due to hemorrhage, complications due to caesarian section, etc.
Hemorrhage, hypertensive disorders of pregnancy, and sepsis account for more than one-half of global maternal deaths

2. Indirect causes

It includes the deaths resulting from previous existing disease, or diseases that developed during pregnancy, and which were not due to direct obstetric causes but aggravated by physiological effects of pregnancy
For example: deaths due to existing cardiac complications
Three Delays (3-D) leading to maternal death
- Delay in deciding to seek care (seeking care)
- Delay in reaching the healthcare facility (reaching care)
- Delay in receiving care (receiving care)

Major Complications Related to Maternal Deaths

The major complications that account for nearly 75% of all maternal deaths 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

Risk Factors of Maternal Mortality

Poor nutritional status of the women
Existing or pre-pregnancy health conditions like obesity, cardiovascular disease
Early pregnancy or pregnancy at older age
Behavioral or life style factors such as smoking cigarettes
Anemia and malaria
Delay in Ante-natal Care and Post-natal Care Checkup
Delivery by unskilled person
Late referral of complications
Occupational status of pregnant females
Lack of awareness and illiteracy
Pregnancy complications such as preeclampsia, gestational diabetes, etc.

Challenges in Reducing Maternal Mortality

Lack of proper health seeking behavior
Considering pregnancy as a normal stage of life
Poverty
Lack of awareness regarding health issues and complications during pregnancy
Distantly placed health facilities
Inadequate and poor quality of health services
Cultural beliefs and practices
Cultural taboos related to pregnancy and childbirth
Food taboos related to pregnancy
Overburdened family responsibility of the female member
Restricted/limited role of men in the family and Sexual, Reproductive Health issues
Lack of proper hygiene and sanitation measures during delivery and child care
Poor practices of institutional delivery in developing countries
Lack of access and utilization of family planning services

Measures to Prevent Maternal Mortality

Promoting women education regarding personal hygiene and pregnancy care
Increasing access to health care for ANC and PNC check-up and skilled birth attendances
Increasing the use of contraception and its availability
Strengthening postpartum monitoring and management of complications
Ensuring behavioral change for mothers such as adopting healthy life style, avoiding smoking.
Preventing malaria, anemia and any other disease that would severely affect maternal health
Strengthening Iron and Folic Acid (IFA) supplementation and vitamin supplementation as per the protocols.
Carrying out nutritional interventions to maintain the optimum nutrition of pregnant mothers
Developing essential package of intervention for care during labor and delivery
Strengthening prevention and management of maternal infection
Promoting and strengthening safe abortion services
Ensuring early detection of pregnancy complications
Preventing three delays (3D) in maternal care
Ensuring family support and care to the women during pregnancy and after child birth
Ensuring proper implementation of national programs on safe motherhood

WHO Response to Reduce Maternal Mortality

World Health Organization (WHO) is striving to reduce maternal mortality through various programs, researches, technical support and developing global standards.

As defined in the Ending Preventable Maternal Mortality Strategy, WHO is working with partners in supporting countries towards:

addressing inequalities in access to and quality of reproductive, maternal, and newborn health care services;
ensuring universal health coverage for comprehensive reproductive, maternal, and newborn health care;
addressing all causes of maternal mortality, reproductive and maternal morbidities, and related disabilities;
strengthening health systems to collect high quality data in order to respond to the needs and priorities of women and girls; and
ensuring accountability in order to improve quality of care and equity.

What is Maternal Mortality Rate (MMR)?

Maternal Mortality Rate (MMR) is defined as the number of maternal deaths in a population divided by the number of women of reproductive age.
MMR depicts not only the risk of maternal death per pregnancy or per birth (live birth or stillbirth), but also the level of fertility in the population
It is a primary and important indicator of a country’s overall health status or quality of life
It is number of maternal death in a given period per 100000 women of reproductive age group at the same time period
MMR = total number of maternal deaths in a specified time/Women of reproductive age group in a specified time

Differences between Maternal Mortality Rate and Maternal Mortality Ratio

Maternal Mortality Rate	Maternal Mortality Ratio
Maternal Mortality Rate is the number of maternal deaths in a population divided by the number of women of reproductive age	Maternal Mortality Ratio is the number of maternal deaths during a given time period per 100,000 live births during the same time period
Maternal Mortality Rate shows not only the risk of maternal death per pregnancy or per birth (live birth or stillbirth), but also the level of fertility in the population	Maternal Mortality Ratio shows the risk of maternal death relative to the number of live births and essentially captures the risk of death in single pregnancy