Dr Daghni Rajasingam
Consultant Obstetrician and Spokesperson, Royal College of Obstetricians and Gynaecologists (RCOG)
Medicine has made giant leaps over the past 100 years, with the birth of penicillin, the contraceptive pill and vaccines, but maternal mortality rates are still devastatingly high.
Every day, around 830 women die from preventable causes linked to pregnancy and childbirth, with 99% of those deaths occurring in developing countries.
The majority of these deaths could be prevented with timely healthcare, trained workforce, appropriate medical supplies and adequate sanitation, but these basic needs are still not widely accessible.
Where are maternal deaths occurring?
The maternal mortality rate is significantly higher in developing countries, with 239 maternal deaths in 100,000 live births compared to 12 in 100,000 in developed countries.
Sub-Saharan Africa accounts for around 66% of the number of maternal deaths globally. Sierra Leone has the highest estimated lifetime risk with approximately one in 17 women losing their lives during pregnancy, childbirth or in the post-partum period.
Why are the figures so high?
The figures remain high for reasons including lack of access to medical care, lack of funding and a dearth of information for women. Many of these are sadly common in developing countries and especially prevalent for women in rural areas, with medical care often unaffordable and/or only accessible by covering significant distance.
Poverty, both on an individual and societal level, leads to higher maternal mortality. This lack of knowledge, and lack of access to information, can contribute to improper sanitation, which increases the risk of disease.
Women lack information on what to expect and poor medical supplies mean screening is not available as easily as in developed countries. There are also low numbers of skilled healthcare workers in a number of regions.
What are the causes of maternal mortality?
The main causes of maternal mortality include severe bleeding, infections, pre-eclampsia and eclampsia and complications from delivering unsafe abortions.
These are all issues that can be mitigated to ensure a safe pregnancy and birth but, unfortunately, the facilities necessary are not available for many women.
A lack of education on pregnancy and the birthing process also contributes to adverse outcomes, with some unable to recognise concerning symptoms.
How do we reduce the number of maternal deaths?
Most maternal deaths are entirely avoidable. Access to antenatal care in pregnancy, special care during childbirth and support after childbirth significantly improve health outcomes for women and their babies.
One target under the UN’s Sustainable Development Goal 3 is to reduce the global maternal mortality ratio to less than 70 per 100,000 births – with no country having a maternal mortality rate of more than twice the average worldwide.
As part of the Global Strategy and goal of Ending Preventable Maternal Mortality, the World Health Organization is working with partners to address the barriers.
Funding is key and international aid is essential in lowering these numbers, but there are also cost-effective options available with little infrastructure required at a local level.
One such example is the RCOG global health programme in South Africa and Tanzania, called Leading Safe Choices. The programme is focused on workforce training to enable over 60,000 women to receive postpartum family planning counselling and contraception after birth. In total, 744 healthcare professionals in 20 facilities were trained, with a focus on long-acting, reversible methods made available to women for free.
This is important because women in developing countries tend to have more pregnancies and, as a result, their lifetime risk of death due to pregnancy is higher.
A woman’s risk of maternal death over her lifetime is 1 in 4,900 in developed countries, compared to 1 in 180 in developing countries. It is also essential women have control over their fertility to enable them to plan when to have a family, and ensure births are spaced out to improve health outcomes.
The RCOG has made maternal health worldwide a key priority – the health of a nation depends on the health of women and girls. We will continue to advocate for the very best in women’s health.