Maternal Survival 1. Maternal Mortality: Who, When, Where, and Why

Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
The Lancet (Impact Factor: 45.22). 10/2006; 368(9542):1189-200. DOI: 10.1016/S0140-6736(06)69380-X
Source: PubMed


The risk of a woman dying as a result of pregnancy or childbirth during her lifetime is about one in six in the poorest parts of the world compared with about one in 30 000 in Northern Europe. Such a discrepancy poses a huge challenge to meeting the fifth Millennium Development Goal to reduce maternal mortality by 75% between 1990 and 2015. Some developed and transitional countries have managed to reduce their maternal mortality during the past 25 years. Few of these, however, began with the very high rates that are now estimated for the poorest countries-in which further progress is jeopardised by weak health systems, continuing high fertility, and poor availability of data. Maternal deaths are clustered around labour, delivery, and the immediate postpartum period, with obstetric haemorrhage being the main medical cause of death. Local variation can be important, with unsafe abortion carrying huge risk in some populations, and HIV/AIDS becoming a leading cause of death where HIV-related mortaliy rates are high. Inequalities in the risk of maternal death exist everywhere. Targeting of interventions to the most vulnerable--rural populations and poor people--is essential if substantial progress is to be achieved by 2015.

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    • "distance, lack of transport, poor quality of primary health care services, poverty, lack of information or education, women's social status [69]. Large disparities remain worldwide in terms of prenatal care coverage and skilled attendance during childbirth [81]. "
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    • "Under the Ghana Health Service safe motherhood guidelines, these complications need to be referred to and managed within a health care facility equipped to manage emergency obstetric care (GHS, 2007). However, preference for home deliveries and use of traditional medical systems continue to limit utilisation of health facilities for child birth and management of complications (Ngom et al., 2003; Ronsmans and Graham, 2006). Studies in Tanzania and Bangladesh show that women still trust TBAs to intervene when severe complications occur during child birth e and although TBAs were found to refer appropriately to other practitioners when the complications were beyond their capability to manage, mothers often did not follow upon the referral due to financial costs, transportation bottlenecks and fear of maltreatment from health care providers (Moyer et al., 2013b; Vyagusa et al., 2013). "
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    ABSTRACT: Traditional medical systems in low income countries remain the first line service of choice, particularly for rural communities. Although the role of traditional birth attendants (TBAs) is recognised in many primary health care systems in low income countries, other types of traditional practitioners have had less traction. We explored the role played by traditional healers in northern Ghana in managing pregnancy-related complications and examined their relevance to current initiatives to reduce maternal morbidity and mortality. A grounded theory qualitative approach was employed. Twenty focus group discussions were conducted with TBAs and 19 in-depth interviews with traditional healers with expertise in managing obstetric complications. Traditional healers are extensively consulted to manage obstetric complications within their communities. Their clientele includes families who for either reasons of access or traditional beliefs, will not use modern health care providers, or those who shop across multiple health systems. The traditional practitioners claim expertise in a range of complications that are related to witchcraft and other culturally defined syndromes; conditions for which modern health care providers are believed to lack expertise. Most healers expressed a willingness to work with the formal health services because they had unique knowledge, skills and the trust of the community. However this would require a stronger acknowledgement and integration within safe motherhood programs. Copyright © 2015 Elsevier Ltd. All rights reserved.
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    • "A previous review found that more than 60% of maternal deaths occur in the postpartum period [18], consistent with the present HHVA results. Other objective (non-self-report) data have established that most maternal deaths occur between the third trimester of pregnancy and the first week postpartum, with the highest risk in the 24 hours around delivery [19]; however, the categories used in that study were not readily transferable to the present data, and it was not possible to access a valid source of data describing timing of pregnancy-related death in Bangladesh to better inform interpretation of the present results. This issue was previously considered to be one of data quality by the BMMS implementers and to reflect the hierarchic structure of questions on the timing of death [13]: for each female death, the HHVA and DS respondents are asked first whether the woman died during pregnancy, then whether she died during delivery, and lastly whether she died during the postpartum period. "
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    ABSTRACT: To compare sociodemographic and pregnancy characteristics of pregnancy-related deaths identified by the direct sisterhood and the verbal autopsy with household mortality (HHVA) methods. Nationally representative data for 1997-2001 were obtained from the household, verbal autopsy, and women's questionnaires of the Bangladesh Maternal Health Services and Maternal Mortality Services Survey, 2001. Sociodemographic and pregnancy characteristics were compared for maternal deaths identified by the two methods. Characteristics of deceased women were reported directly with HHVA, but extrapolated in the direct sisterhood method using the reporting sister as proxy. Overall, 201 pregnancy-related deaths were identified via HHVA and 388 through DS reporting. There were no significant differences between reporting sister characteristics and deceased women's characteristics in educational attainment, working status, husband's educational attainment, and spouse educational parity. However, timing of death relative to pregnancy phase, number of previous live births, and years since death did differ (P<0.05). The sociodemographic characteristics of women with pregnancy-related deaths identified via the two methods were similar. However, some pregnancy characteristics differed significantly, suggesting that different policy interventions are required. Before considering using sister proxy characteristics to target services, issues responsible for these differences should be resolved, and generalizability of evaluated indicators must be considered. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
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