Dying: Millions of women in childbirth, newborns, and young children

Why high death rates

Beyond poverty, the analysis pinpoints the many reasons for continuing high rates of death during childbirth, both of women and newborns.

Most newborn deaths are due to conditions rarely seen in high-income countries: infections, birth complications, preterm birth - even babies who are just a few weeks preterm often do not survive for lack of simple care.

Women in childbirth die from hemorrhage, infections, hypertensive disorders, obstructed labor, and unsafe abortions. In some countries, HIV/AIDS and malaria are also important causes.

Many of these deaths could be prevented with a maternal and newborn health program that includes continuing prenatal care, hygienic care during childbirth and the postnatal period.

In some parts of the world, traditions add to the risk faced by families. In parts of south Asia, for example, childbirth is considered dirty, so women are forced to deliver their babies in cowsheds, where they must stay for one month. Cords may be cut with dirty tools, leading to possible infection. “Strong cultural practices hide the problem. Families know many mothers and babies will die so they just accept it,” says Dr. Lawn. “But this does not mean they do not care. Mourning is hidden”.

“Countries are unlikely to meet the goals unless they prioritize the delivery of life-saving interventions to those who need them most,” says Dr. Bhutta.

Another major barrier is a shortage of skilled health care and community workers in many parts of the world. One way to ease this shortage is to upgrade skills of existing workers, so that nurses and outreach workers can provide medications and surgeon assistants can perform caesarean sections where no obstetrician is available, as has been done successfully in Mozambique. Another is to recruit and train additional health workers and provide incentives for work in remote and underserved areas.

And, while the need for more research always exists, the failure to use proven techniques more widely poses yet another barrier to rapid progress. Examples are kangaroo mother care, improved techniques to manage child birth, and providing routine postnatal visits to newborns soon after delivery to advise the family on breast feeding and keeping the baby warm, and to check for cord infection or other problems.