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02/01/2013

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Maternal mortality

WHO / MPS Every day, 1500 women die from pregnancy- or childbirth-related complications. In 2005, there were an estimated 536 000 maternal deaths worldwide. Most of these deaths occurred in developing countries, and most were avoidable. (1) Improving maternal health is one of the eight Millennium Development Goals adopted by the international community at the United Nations Millennium Summit in 2000. In Millennium Development Goal 5 (MDG5), countries have committed to reducing the maternal mortality ratio by three quarters between 1990 and 2015. However, between 1990 and 2005 the maternal mortality ratio declined by only 5%. Achieving Millennium Development Goal 5 requires accelerating progress.
(1) Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www. who.int/reproductive-health/publications/maternal_mortality_2005/index.html, accessed 14 August 2008).

Where do maternal deaths occur? The high incidence of maternal death is one of the signs of major inequity spread throughout the world, reflecting the gap between rich and poor.

Cameroon. accessed 14 August 2008). Rwanda.The designation employed and the presentation of the material on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country. Guinea-Bissau. the Democratic Republic of the Congo. 2007 (http://www. or concerning the delimitation of its frontiers or boundaries. UNFPA and the World Bank. Niger. where women¶s lifetime risk of dying from pregnancyrelated complications is 1 in 7 versus 1 in 48 000 in Ireland.int/reproductive-health/publications/maternal_mortality_2005/index. Malawi. Sierra Leone and Somalia. Burundi.(1) In addition to the differences between countries. city or area or of its authorities. .html. Fourteen countries have maternal mortality ratios of at least 1000 per 100 000 live births. More than half of these deaths occur in sub-Saharan Africa and one third in South Asia. of which all but Afghanistan are in sub-Saharan Africa: Afghanistan. A total of 99% of all maternal deaths occur in developing countries. But the difference is more striking in Niger. Liberia. where 85% of the population lives. (1) Maternal mortality in 2005: estimates developed by WHO. there are also large disparities within countries between people with high and low income and between rural and urban populations. World Health Organization. UNICEF. Geneva. A woman¶s lifetime risk of maternal death is 1 in 7300 in developed countries versus 1 in 75 in developing countries. The maternal mortality ratio in developing countries is 450 maternal deaths per 100 000 live births versus 9 in developed countries.(1) Because women in developing countries have many pregnancies on average. their lifetime risk more accurately reflects the overall burden of these women. who. Dashed lines represent approximate border lines for which there may not be yet full agreement. Chad. Nigeria. Angola. territory.

childbirth or the postpartum period. accessed 14 August 2008). hypertensive disorders in pregnancy (eclampsia) and obstructed labour.who.int/whr/2005/en. Geneva.(2) Women also die because of poor health at conception and a lack of adequate care needed for the healthy outcome of the pregnancy for themselves and their babies. The four major killers are: severe bleeding (mostly bleeding postpartum). 2005 (http://www. . Complications after unsafe abortion cause 13% of maternal deaths. about 80% of maternal deaths are due to these causes. infections (also mostly soon after delivery).Why do mothers die? Women die from a wide range of complications in pregnancy. Most of these complications develop because of their pregnant status and some because pregnancy aggravated an existing disease. World Health Organization. This will reduce unwanted pregnancies and unsafe abortions. such as malaria. How can the mothers' lives be saved? WHO / Marie-Agnes Heine The first step for avoiding maternal deaths is to ensure that women have access to family planning and safe abortion. anaemia and HIV. Globally. (2) The world health report 2005 ± Make every mother and child count. Among the indirect causes (20%) of maternal death are diseases that complicate pregnancy or are aggravated by pregnancy.

which occurs when the fetus¶ head is too big compared with the mother¶s pelvis or if the baby is abnormally positioned. virtually all women have at least four antenatal care visits. a common hypertensive disorder. For women to benefit from those cost-effective interventions they must have antenatal care in pregnancy. Injecting the drug oxytocin immediately after childbirth reduces the risk of bleeding very effectively. especially at birth. Sepsis ± a very severe infection ± is the second most frequent cause of maternal death. in childbirth they must be attended by skilled health providers and they need support in the weeks after the delivery. as the health care solutions to prevent or manage the complications are well known. just 12%. a graph of progress of labour and the maternal and fetal condition. Most maternal deaths are avoidable. which can be fatal. emerges as pre-eclampsia. Skilled practitioners can use the partograph to recognize and deal with slow progress before labour becomes obstructed. if necessary. are attended by a midwife and/or a doctor for childbirth and receive postnatal care. which can be detected during pregnancy.(5) This means that 45 million home deliveries each year are not assisted by skilled health personnel. A simple tool for identifying problems early in labour is the partograph. Since complications are not predictable. Another frequent cause of maternal death is obstructed labour. as in Ethiopia.The women who continue pregnancies need care during this critical period for their health and for the health of the babies they are bearing. Why do mothers not get the care they need? WHO / Jim Holmes Data show that less than two thirds (62%) of women in developing countries receive assistance from a skilled health worker when giving birth. administering drugs such as magnesium sulfate can lower a woman¶s risk of developing convulsions (eclampsia). severe bleeding after birth can kill even a healthy woman within two hours if she is unattended. but in some countries less than one third have this or. ensure that Caesarean section is performed on time to save the mother and the baby. It can be eliminated if aseptic techniques are respected and if early signs of infection are recognized and treated in a timely manner. all women need care from skilled health professionals.(4) .and middleincome countries. For instance. just above two thirds of women get at least one antenatal care visit. In low. Although pre-eclampsia cannot be completely cured before the delivery. eclampsia. when rapid treatment can make the difference between life and death. and. In high-income countries. The third cause.

In 2007.who. The 63% average for lowand middle-income countries covers large differences: from 34% in eastern Africa to 93% in South America. Many pregnant women do not get it because there are no services where they live.int/reproductive_ health/global_monitoring/data. (4) WHO and UNICEF. WHO advocates for a social.int/reproductive_health/ global_monitoring/data. Geneva. We assist countries in collaboration with other parts of the Organization and experts in WHO regional and country offices. Tracking progress in maternal.html. (3) There are many reasons why women do not receive the care they need before.php?option=com_content&view=article&id=68&itemid=61. newborn & child survival: the 2008 report. World Health Organization. Some women do not use services because they do not like how care is provided or because the health services are not delivering high-quality care. Antenatal care in developing countries: promises. accessed 14 August 2008). we celebrated ± together with partners ± the 20th anniversary of Safe Motherhood. they cannot afford the services because they are too expensive or reaching them is too costly. We aim to reduce maternal mortality by providing and promoting evidence-based clinical and programmatic guidance. United Nations Children¶s Fund. gaps in the capacity and quality of health systems and barriers to accessing health services must be identified and tackled at all levels. down to the community. A set of guidelines under a common title Integrated Management of Pregnancy and Childbirth (IMPAC) assists countries in addressing the main problems facing . Through the Department of Making Pregnancy Safer. political and economic environment conducive to action in countries. Countdown to 2015. WHO is providing guidance to countries for improving maternal health. WHO/UNICEF 2003 (http://www. safe and culturally appropriate services. during and after childbirth.html. Further. cultural beliefs or a woman¶s low status in society can prevent a pregnant woman from getting the care she needs. accessed 14 August 2008). A cornerstone of the WHO guidance is guidelines on effective. countdown2015mnch.org/index.who. In addition.Even fewer women have the birth attended by a skilled health worker. What does MPS do to reduce maternal mortality? Maternal health is one of WHO¶s priority areas. achievements and missed opportunities. efficient. New York. 2008 (http://www. (3) Proportion of births attended by a skilled health worker ± 2008 updates. an initiative that placed maternal mortality on the global agenda. 2008 (http://www. To improve maternal health.

The guidelines are supported by other tools that help countries¶ implementation according to their needs and capacity.8 million die in the first week of life and slightly less than 1 million in the following three weeks. When their mother dies.pregnant women and their newborn infants. The rates vary from 7 per 1000 births in high-income countries to 74 per 1000 births in central Africa. To advance these approaches.and middle-income countries. eclampsia and infection such as syphilis. 2. tools for costing programmes that will increase women¶s access to the care they need and methods and instruments for monitoring what they are doing and for measuring progress in reducing maternal mortality. The causes of these deaths are similar to the causes of maternal deaths: obstructed or very long labour. The patterns of babies¶ deaths are similar to the patterns of maternal deaths: large numbers in Africa and Asia and very low numbers in high-income countries. Poor maternal health and diseases that have not been adequately treated before or during pregnancy contribute to intrapartum death but also contribute to many babies born preterm and with low birth weight. families and communities in increasing access to high-quality care. Among the 133 million babies who are born alive each year. Every year 3 million babies are stillborn. 90% in low. . What about babies Every year more than 133 million babies are born. the chance of their surviving is meagre. WHO also promotes the involvement of individuals. Neonatal tetanus is still killing 100 000 babies a year. The exact number is not known since only one third of babies are weighed at birth. Almost one quarter of these die during birth. such as how to set policies that address country needs. Lack of maternal care is causing a large burden of babies¶ deaths and disability among infants. staff of the WHO Department of Making Pregnancy Safer and WHO staff in the regions organize workshops to orient health programme managers and provide ongoing technical support to countries. We guide critical actions that are necessary in countries to ensure that enough well-trained midwives and doctors become available. About 20 million (17%) are born with low birth weight.

and many babies are disabled. At present it is too difficult to measure how many disabled infants ± infants with cerebral palsy.Interventions for saving babies¶ lives are very similar to those that save maternal lives. Although the underlying causes differ. many women must live with an obstetric fistula because of childbirth complications. This combined toll that mother and babies are paying for inadequate services should be considered when maternal mortality is being discussed. Infants who survive either maternal or neonatal complications have high morbidity and resulting disability.3 million lives lost every year. poor maternal health and lack of services are the most important factors. Related links y y Maternal mortality in 2005 The World Health Report 2005 ± Make every mother and child count Information y y E-mail Print . Further. Maternal and perinatal deaths (stillbirths and firstweek deaths) together add up to 6. mental retardation or visual or auditory impairment ± are among the survivors. Many are among the babies who die later in infancy and childhood.

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