Maternal Mortality

And
Safe Motherhood
Dr. Syed Tafazzul Hyder Zaidi
Associate Professor,
Community Medicine
Department,
SMC, JSMUK
Objectives

Understand Maternal mortality as a
Public Tragedy

Identify the Causes of High Maternal
Mortality Rate in South-East Asia

Compare the causes of maternal
mortality in the world with South-East
Asia

Enumerate Risk Factors for maternal
mortality
Objectives/2

Apply Three Delay’s Concept

Use Maternal Mortality Rate as

indicator to assess the difference
between Health Services provided and
utilized

Appreciate the concept of Maternal

Life as “Worth Saving”
Lecture Details:
Definition of Maternal mortality
according to WHO
Situation of maternal mortality in
different parts of world
Preventable Deaths in South-East
Asia
Situation in Pakistan
Major risk factors of maternal
mortality
Three Delays in maternal mortality
Lecture Details:
Comparison Between Maternal
Mortality Rate And Maternal
Mortality Ratio
Major Causes of maternal mortality
rate identified by WHO
Major Causes of maternal mortality
identified by Society of Gynecology
and Obstetricians Pakistan (SOGP)
WHO Strategy for Safe Motherhood
In Pictures; fighting maternal
mortality
 Maternal Mortality:
"A Maternal Death 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."
Death of Mother
Preventable Deaths in South Asia
According to UNICEF

India (117,000)

Afghanistan (26,000)

Bangladesh (21,000)

Pakistan (15,000)
In many countries, the majority of births
occur at Home in rural areas Without
Qualified Medical Help.
Situation in Pakistan

Over 5 Million Deliveries take place in

Pakistan each year.

maternal deaths are very high in
Pakistan exact numbers are not available
because of NO Compulsory Registration.

WHO And UNICEF estimates maternal
mortality for Pakistan at 184 Per 100,000
Live Births in 2014
Maternal Mortality Ratio
“It is the Number Of Women who
Die as a result of Complications Of
Pregnancy and Child Bearing in a
given year Per 100,000 Live Births in
that year. “

Deaths due to spontaneous or

induced Abortions are also included
Maternal Mortality Rate
Maternal Mortality Rate would
Divide the Number Of Maternal
Deaths by the Number Of Women
Of Childbearing Age in a population
Maternal Mortality Ratio Formula
Number Of
Maternal Deaths X 100,000

Number Of Live Births

Maternal Mortality Rate Formula
Number Of
Maternal Deaths X 100,000
Number Of Women
Of Childbearing Age
In Population
Maternal Morbidity
“Any Cause Related To Or Aggravated
By The Pregnancy Or Its
Management”
Maternal Morbidity/2
it may be

Direct Obstetric morbidity

Indirect Obstetric morbidity
Major Causes of
Maternal Deaths
As stated by WHO in 2017
A.Direct Causes(80%)

Severe Bleeding/Hemorrhage (25%)

Infections (13%)

Unsafe Abortions (13%)

Eclamptia (12%)

Obstructed Labour (8%)
Major Causes of Maternal Deaths/2
B.Indirect Causes (20%)

Malaria

Anaemia

HIV/AIDS

Cardiovascular Disease

These causes complicate pregnancy or

are aggravated by it.
Sad But True…!!!

45% of Postpartum Deaths occur
within 24 Hours.

Over 90% of Maternal Deaths

occur in Developing Countries
 WHO Strategies for
Safe Motherhood

Family Planning

Antenatal Care

Clean / Safe delivery

Essential Obstetric Care
Maternal deaths due to other
factors (Three Ds)
Maternal deaths are also caused by
Social, Cultural and Economic factors.

1) Delay In Family’s Decision Making.

2) Delay in Transportation
3) Delay In Proper Treatment Or Referral
At The Hospital
 1) Delay To Seek Care
“She Can’t Decide Herself to come to the
hospital because of Family Pressure,” she
must not show the pain, and Her Baby
Dies, and she is Injured.”
2) Delay To Reach Proper Medical Services
“I tried to get together enough people to
carry her to the clinic, but there was no
one around,” husband said. “After She
Died, I felt sad for a long time. I Could Not
Work. The Children Suffered too”

To far to Walk
3)Delay In Accessing Quality Care
1) "We took her to the Health Center In
The Village
2) She was examined by the Nurse who
later Transferred Her To Another
Health Center .
3) There she Spent The Night
4) Following Morning She was Again
Transferred To The Hospital
5) Immediately after we reached the
hospital She Died".
Risk Factors for Maternal Mortality

Young Age of mothers, less than 18
Years

Primigravida, women having first child

Previous Poor Pregnancy Outcome,

Previous Abortions, Premature
Deliveries or Still Births.
Risk Factors for Maternal
Mortality/2

Delay in seeking Appropriate Care---
Family's delay in seeking help for
Different reasons
 Risk Factors for Maternal
Mortality/3

Inappropriate Treatment---treatment
received by the patient in the health
facility was delayed and not appropriate
Health Services

The Basic Health Units (BHUs)

The Rural Health Centers (RHCs)

The Mother and Child centers (MCHs)

The services are Free Of Cost but
Quality Of Care Is Poor and most of the
facilities are Not Easily Accessible.

In the Health System Referral Chain to
Secondary and Tertiary facilities is
almost Non Existent.
Percentage of births assisted by a Skilled
Birth Attendant, By Country, 2017
 Utilization of Health Services
Improvement

Improving the Efficiency And Utilization
of basic health care.

Improving program design by paying
more attention to Quality

Increasing Access to health care by
Constructing More Facilities

Increasing women's access by recruiting
more Female Staff

Promoting Community Participation
In Pictures, Fighting Maternal
Mortality
Source; bbc.news.com.uk
 Trauma
Ana is waiting to give birth to Her Third
Child At Home. The chances are that she
will have to do so Without the help of a
Midwife or Doctor.

(Photos: Unicef)
Complications
Fifteen-year-old Chand's baby was also
born in Karachi, but at home with No
Medical Help. The baby suffers from a
Neurological Disorder and is in an
incubator.

(Photos: Unicef)
Preventable Deaths
29-year-old Naleeb's newborn child in
Kabul is Not Expected To Survive.

(Photos: Unicef)
Simple Solutions
Unicef Report Says.
"The Positive Developments have Failed to
trickle down to the Poorest Sectors of
society is due to a these factors:

Religious

Cultural Practices

Political

Economic Exclusion

Gender Bias.
 'Worth Saving'
"These women are dying Not Because
We Don't Have The Means to save
them, But Because we have not
determined Whether They Are Worth
Saving."
Millennium Development Goals