Maternal health epidemiology
A maternal death is defined as "the death of a women 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."1
In 2008, an estimated 358 000 women died from pregnancy - or childbirth-related complications. More than 60% of maternal deaths occurred in the postpartum period. The risk of death is highest close to birth and then decreases over the subsequent days and weeks. About 45% of postpartum maternal deaths occur within 1 day of delivery, more than 65% within 1 week, and more than 80% within 2 weeks.
More than three-quarters of maternal deaths were concentrated in just two regions of the world: 53% in the African Region and 25% in South-East Asia. The vast majority of maternal deaths occurred in developing countries. The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. There are large disparities between countries: the average maternal mortality ratio in developing countries is 290 per 100 000 live births versus 14 per 100 000 live births in developed countries. There are also large disparities within countries, between people with high and low income and between people living in rural and urban areas. Adolescents face a higher risk of complications and death as a result of pregnancy than older women.
Between 1990 and 2008, maternal deaths worldwide have dropped by 34%. However, the global maternal mortality ratio declined by only 2.3% per year in this same period. This is far from the annual decline of 5.5% required to achieve MDG5. In sub-Saharan Africa, a number of countries have halved their levels of maternal mortality since 1990. In other regions, including Asia and North Africa, even greater progress has been made.
Causes of maternal mortality
Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy. Other complications may exist before pregnancy but are worsened during pregnancy.
The major complications that account for 80% of all maternal deaths are: severe bleeding, infections, high blood pressure during pregnancy (pre-eclampsia and eclampsia), obstructed labour, and unsafe abortion. Of these, haemorrhage and hypertensive disorders account together for the largest proportion of maternal deaths in developing countries. Most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. All women need access to skilled care and emergency obstetric care during pregnancy, childbirth, and after childbirth, as timely management and treatment can make the difference between life and death. Many women do not access the care they need for different reasons including low quality and availability, prohibitive costs, transport, household decision-making among others.
Source: The world health report 2005 – make every mother and child count
A systematic review conducted by WHO provides a regional distribution of causes of maternal deaths. WHO is currently in the process of updating that review with the aim of providing up-to-date global/regional/sub-regional estimates, and will be collaborating with Child Health Epidemiology Reference Group (CHERG) to finalize this effort.
1 Trends in maternal mortality 1990-2008: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, WHO 2010.
2 Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. Lancet, 2006; 367: 1066-74