SEATTLE — To many people in developed countries, Maternal Mortality may seem like a thing from the past. However, the Maternal Mortality Rate (MMR) is still extremely high in some regions of the world, including in Sub-Saharan Africa (which accounts for half of the maternal deaths) and South Asia (where one-third of the maternal deaths occur).
Maternal Mortality is defined by the World Health Organization 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.” While a large variety of factors contribute to Maternal Mortality, there are some factors that are extremely common and contribute to the largest number of maternal deaths, such as the 10 common causes of Maternal Mortality listed below.
1. Hemorrhages: Post-Partum Hemorrhages account for more than 30 percent of the maternal deaths in Africa and Asia. Post-Partum Hemorrhages are excessive bleeding after a woman has given birth. After a woman gives birth, the uterus is supposed to continue contracting in order to expel the placenta. If this does not occur, and the uterus does not contract strongly enough, the blood vessels bleed freely, creating a hemorrhage. Hemorrhages are problematic because many clinics do not have the resources and the blood needed for transfusions, so mothers die from blood loss.
2. Infections (usually after childbirth): Infections related to pregnancy, or even infections that are not at all related to the pregnancy, like urinary tract infections or pneumonia, can trigger the body and cause sepsis, the body’s inflammatory response to the infection. Sepsis is also called blood poisoning and can be deadly. While Sepsis can be treated with a prompt delivery of antibiotics, many women do not get the treatment that they need.
3. Eclampsia: According to the National Institute of Health (NIH), eclampsia convulsions in a pregnant woman resulting from high blood pressure which are often followed by a coma, is one of the top three causes of maternal mortality worldwide. Preeclampsia is the number one cause of maternal deaths in Latin America, and women in developing countries are seven times more likely to suffer from preeclampsia than those in developed countries.
4. Unsafe Abortions: About 20 million abortions annually are unsafe, and as a result, over 68,000 women die from unsafe abortions annually, accounting for about 13 percent of maternal mortalities. Unsafe abortions are also problematic because they can lead to health complications later on for women who do survive the abortion—about 5 million women who undergo unsafe abortions have long-term health complications.
5. Child Marriage: Among girls aged 15-19 in low and middle-income countries, complications in pregnancy and childbirth are the leading cause of death. Since their bodies are still developing, child brides are vulnerable to many health complications, the most common being obstetric fistulas, 65 percent of which affect girls under the age of 18. Child brides are also normally not given the power to choose to use contraceptives. A study by Dr. Anita Raj and by Dr. Ulrike Bohmer demonstrates that a 10 percent reduction in a country’s rate of child marriage could be linked to a 70 percent reduction in the country’s MMR.
6. Lack of Access to Healthcare: Rural women are most susceptible to Maternal Mortality. Many of them have no assistance at their home births or the assistance of a Traditional Birthing Attendant who has not been formally trained. Rural women are also less likely to be able to afford proper healthcare or to be able to travel the distance to a hospital, therefore making the MMR higher in rural areas.
7. HIV: HIV is linked to maternal mortality. From 1990 to 2008, nine percent of maternal deaths in Sub-Saharan Africa were linked to the HIV infection, and about five percent of maternal deaths worldwide are connected to HIV. It is not known exactly how HIV causes maternal mortality—some suggest that pregnancy accelerates the progression of HIV, while others think HIV infections increase the risk of obstetric complications.
8. Lack of Contraceptives: There is still a stigma associated with contraceptive use in many countries, because many consider them unethical or anti-religious. For example, in Nigeria, contraceptive use is seen as ‘denying God’s gift,’ and is therefore discouraged. Some countries, such as Kenya, have started to celebrate ‘international condom day’ in order to help de-stigmatize contraceptive use. However, many women who want contraceptives do not currently have access to them, and if all the women who wanted contraceptives obtained them, the maternal mortality rate would decrease by as much as one-third.
9. Women treated as inferiors in society: Many women are not given the power to choose whether or not they want to use contraceptives and whether or not they want to have children. Patriarchal societies where the men look down on the women are another factor that leads to higher Maternal Mortality Rates.
10. Poor Sanitation: Sepsis can be caused by unhygienic conditions while giving birth. Poor sanitation can also lead to other infections and health problems, thereby increasing the MMR. People who give birth in conditions with inadequate sanitation have a 48 percent greater chance of maternal death than those who give birth in places with adequate sanitation.
– Ashrita Rau
Sources: The Borgen Project, WHO 1, WHO 2, Children’s Hospital of Wisconsin, Sepsis Alliance, Every Mother Counts, UNICEF, UCSD, Girls Not Brides, UCLA, New York Times, United Nations University, National Center for Biotechnological Information 1, National Center for Biotechnological Information 2, National Center for Biotechnological Information 3, Preeclampsia
Photo: Girls’ Globe