Maternal mortality To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. Evidence brief Key facts ` In 2015, approximately 830 women die from preventable causes related to pregnancy and childbirth. ` 95% of all maternal deaths occur in in low and lower-middle income countries. ` Young adolescents (aged 10-14) face a higher risk of complications and death as a result of pregnancy than older women. ` Appropriate care provided by skilled health professionals competent in sexual and reproductive health care, before, during and after childbirth can save the lives of women and newborn babies. ` Between 1990 and 2015 maternal mortality worldwide dropped by almost 44%. Maternal mortality is unacceptably high. About 830 women die from pregnancy- or childbirth-related complications around the world every day. In 2015, 303 000 women died during and following pregnancy and childbirth.1 Almost all of these deaths occurred in low-resource settings, and most could have been prevented. Progress towards achieving the Sustainable Development Goals Improving maternal health is one of the seventeen Sustainable Development Goals (SDGs) adopted by the international community in 2015. Under SDG3.1.1, countries committed to ending preventable maternal mortality and to reach a global maternal mortality ratio of less than 70. To reach this goal, most countries should decrease their maternal mortality by two-thirds and no country should have a MMR in 2030 more than twice the global average. This is an ambitious but achievable goal. Historically between 1990 to 2015, maternal deaths were reduced globally declined at a rate of 2.3% annually, but some countries achieved rates of decline of over 7%. (1) Where do maternal deaths occur? 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. Almost all maternal deaths (95%) occurred in low-income and lower-middle-income countries, and almost two thirds (65%) occurred in the World Health Organization (WHO) African Region. (1) The maternal mortality ratio in developing countries is 239 per 100 000 births versus 12 per 100 000 in developed countries. There are large disparities between countries, with some countries having extremely high maternal mortality ratios of 500 or more per 100 000 live births. (1) The risk of maternal mortality is highest for adolescent girls under 15 years old. (2) Complications in pregnancy and childbirth are the leading cause of death among adolescent girls aged 15-19 in most developing countries. (3) Women in low and lower middle-income countries have on average many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is higher. (4) A woman’s lifetime risk of maternal death – the probability that a 15-year-old woman will eventually die from a maternal cause – is 1 in 3300 in high income countries, versus 1 in 41 in low income countries. (1) Why do women die? Women die as a result of complications during pregnancy, childbirth and post-partum. 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 (5): • severe bleeding (mostly bleeding after childbirth) • infections (usually after childbirth) • high blood pressure during pregnancy (pre- eclampsia and eclampsia) • unsafe abortion. The remainder are caused by or associated with complications (such as malaria or pre-existing or non- communicable disease such as diabetes and heart disease)malaria HIV during pregnancy. Maternal health and newborn health are closely linked. Nearly 2.5 million children die in the 1st month of life every year, and an additional 2.6 million babies are stillborn. (6,7). How can women’s lives be saved? Most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. All women need access to high quality care provided by competent skilled health professionals during pregnancy (antenatal care), during childbirth (intrapartum care), and care and support in the weeks after childbirth (postnatal or postpartum care). It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death. Severe bleeding after birth can kill a healthy woman within two hours if she is unattended. Injecting oxytocin immediately after childbirth effectively reduces the risk of bleeding. Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of infection are recognized and treated in a timely manner. Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia. To avoid maternal deaths, it is also vital to prevent unwanted and too-early pregnancies. All women, including adolescents, need access to family planning, safe abortion services to the full extent of the law, and quality post-abortion care. Why do women not get the care they need? Poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health professionals, such as sub-Saharan Africa and South Asia. While levels of antenatal care have increased in many parts of the world during the past decade, just over 50% of women in low-income countries benefit from care by a skilled health professional e during childbirth. (8) This means that millions of births are not assisted by a midwife, a doctor or a nurse with specific competencies to manage labor and delivery. In high-income countries, virtually all women have at least four antenatal care visits, are attended by a skilled health worker during childbirth and receive postpartum care. Coverage of deliveries by a skilled birth attendant ranges from 59% in the WHO African Region to over 90% in the Region of the Americas, and in the European and Western Pacific regions. (8) Just 60% of births are attended by skilled health personnel in low-income countries compared to nearly 100% in upper-middle-income and high- income countries. (8) Other factors that prevent women from receiving or seeking care during pregnancy and childbirth are: • poverty • distance • lack of information • inadequate services • cultural practices. To improve maternal health, barriers that limit availability and access to quality maternal health services must be identified and addressed at all levels of the health system. WHO response Improving maternal health is one of WHO’s key priorities. WHO is working to reduce maternal mortality by providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States. In addition, WHO advocates for more affordable and effective treatments, designs training materials and guidelines for health workers, and supports countries to implement policies and programmes and monitor progress. A renewed commitment to maternal health was made with the Global strategy for women’s and children’s and Adolescent’s health (2016-2030). WHO is working with partners to accelerate progress towards improved health and well-being of women, children, and adolescents. (9) 1. Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario- based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387 (10017): 462-74. 2. Neal S, Matthews Z, Frost M, et al. Childbearing in adolescents aged 12–15 years in low resource countries: a neglected issue. New estimates from demographic and household surveys in 42 countries. Acta Obstet Gynecol Scand 2012;91: 1114–18 3. Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva: WHO; 2016 (special tabulations were done, as source does not provide information for ages 15-19 years). 4. Zimicki S. The relationship between fertility and maternal mortality. In: Parnell A (ed), Contraceptive use and controlled fertility: health issues for women and children (background papers). Washington DC: National Research Council (US), National Academies Press (US); 1989 (https:// www.ncbi.nlm.nih.gov/books/ NBK235085/, accessed 17 March 2019). 5. Global Causes of Maternal Death: A WHO Systematic Analysis. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels JD, et al. Lancet Global Health. 2014;2(6): e323-e333. 6. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME), ‘Levels & Trends in Child Mortality: Report 2018, Estimates developed by the United Nations Inter-agency Group for Child Mortality Estimation’, United Nations Children’s Fund, New York, 2018. https:// childmortality.org/wp-content/uploads/2018/12/UN- IGME-Child-Mortality-Report-2018.pdf, accessed 10 July 2019. 7. Blencowe, Hannah et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health, Volume 4, Issue 2, e98 - e108 (https://www.thelancet.com/ journals/langlo/article/PIIS2214-109X(15)00275-2/fulltext), accessed 10 July 2019. 8. World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO. 9. Every Woman Every Child. The Global Strategy for Women`s, Children`s and Adolescents` Health (2016-2030). Geneva: Every Woman Every Child, 2015. Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland E-mail: reproductivehealth@who.int www.who.int/reproductivehealth Photo: Photoshare/Valerie Caldas WHO/RHR/14.06 Rev.1 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence.
Maternal mortality To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. fact sheet Key facts ` Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. ` 99% of all maternal deaths occur in developing countries. ` Maternal mortality is higher in women living in rural areas and among poorer communities. ` Young adolescents face a higher risk of complications and death as a result of pregnancy than older women. ` Skilled care before, during and after childbirth can save the lives of women and newborn babies. ` Between 1990 and 2010, maternal mortality worldwide dropped by almost 50%. Maternal mortality is unacceptably high. About 800 women die from pregnancy- or childbirth-related complications around the world every day. In 2010, 287 000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. Progress towards achieving the fifth Millennium Development Goal Improving maternal health is one of the eight Millennium Development Goals (MDGs) adopted by the international community in 2000. Under MDG5, countries committed to reducing maternal mortality by three quarters between 1990 and 2015. Since 1990, maternal deaths worldwide have dropped by 47%. 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 headway has been made. However, between 1990 and 2010, the global maternal mortality ratio (i.e. the number of maternal deaths per 100 000 live births) declined by only 3.1% per year. This is far from the annual decline of 5.5% required to achieve MDG5. Where do maternal deaths occur? 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. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. The maternal mortality ratio in developing countries is 240 per 100 000 births versus 16 per 100 000 in developed countries. There are large disparities between countries, with few countries having extremely high maternal mortality ratios of 1000 or more per 100 000 live births. There are also large disparities within countries, between people with high and low income and between people living in rural and urban areas. The risk of maternal mortality is highest for adolescent girls under 15 years old.1, 2 Complications in pregnancy and childbirth are the leading cause of death among adolescent girls in most developing countries.1, 2 Women in developing countries have on average many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is higher. A woman’s lifetime risk of maternal death – the probability that a 15 year old woman will eventually die from a maternal cause – is 1 in 3800 in developed countries, versus 1 in 150 in developing countries. Why do women die? 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 (mostly bleeding after childbirth) • infections (usually after childbirth) • high blood pressure during pregnancy (pre- eclampsia and eclampsia) • unsafe abortion. The remainder are caused by or associated with diseases such as malaria, and AIDS during pregnancy. Maternal health and newborn health are closely linked. Nearly three million newborn babies die every year, and an additional 2.6 million babies are stillborn.3 How can women’s lives be saved? Most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death. Severe bleeding after birth can kill a healthy woman within two hours if she is unattended. Injecting oxytocin immediately after childbirth effectively reduces the risk of bleeding. Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of infection are recognized and treated in a timely manner. Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia. To avoid maternal deaths, it is also vital to prevent unwanted and too-early pregnancies. All women, including adolescents, need access to family planning, safe abortion services to the full extent of the law, and quality post-abortion care. Why do women not get the care they need? Poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. While levels of antenatal care have increased in many parts of the world during the past decade, only 46% of women in low-income countries benefit from skilled care during childbirth. This means that millions of births are not assisted by a midwife, a doctor or a trained nurse. In high-income countries, virtually all women have at least four antenatal care visits, are attended by a skilled health worker during childbirth and receive postpartum care. In low-income countries, just over a third of all pregnant women have the recommended four antenatal care visits. Other factors that prevent women from receiving or seeking care during pregnancy and childbirth are: • poverty • distance • lack of information • inadequate services • cultural practices. To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. WHO response Improving maternal health is one of WHO’s key priorities. WHO is working to reduce maternal mortality by providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States. In addition, WHO advocates for more affordable and effective treatments, designs training materials and guidelines for health workers, and supports countries to implement policies and programmes and monitor progress. During the United Nations MDG summit in September 2010, UN Secretary-General Ban Ki-moon launched a Global strategy for women’s and children’s health, aimed at saving the lives of more than 16 million women and children over the next four years. WHO is working with partners towards this goal. 1. Conde-Agudelo A, Belizan JM, Lammers C. Maternal- perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 2004. 192:342–349. 2. Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet, 2009, 374:881–892. 3. Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, Creanga AA, Tunçalp O, Balsara ZP, Gupta S, Say L, Lawn JE. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet, 2011, Apr 16;377(9774):1319- 30. Photo: Photoshare/Valerie Caldas WHO/RHR/14.06 © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published materi- al is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland E-mail: reproductivehealth@who.int www.who.int/reproductivehealth
Maternal mortality To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. fact sheet Key facts ` Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth. ` 99% of all maternal deaths occur in developing countries. ` Maternal mortality is higher in women living in rural areas and among poorer communities. ` Young adolescents face a higher risk of complications and death as a result of pregnancy than older women. ` Skilled care before, during and after childbirth can save the lives of women and newborn babies. ` Between 1990 and 2010, maternal mortality worldwide dropped by almost 50%. Maternal mortality is unacceptably high. About 800 women die from pregnancy- or childbirth-related complications around the world every day. In 2010, 287 000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. Progress towards achieving the fifth Millennium Development Goal Improving maternal health is one of the eight Millennium Development Goals (MDGs) adopted by the international community in 2000. Under MDG5, countries committed to reducing maternal mortality by three quarters between 1990 and 2015. Since 1990, maternal deaths worldwide have dropped by 47%. 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 headway has been made. However, between 1990 and 2010, the global maternal mortality ratio (i.e. the number of maternal deaths per 100 000 live births) declined by only 3.1% per year. This is far from the annual decline of 5.5% required to achieve MDG5. Where do maternal deaths occur? 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. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. The maternal mortality ratio in developing countries is 240 per 100 000 births versus 16 per 100 000 in developed countries. There are large disparities between countries, with few countries having extremely high maternal mortality ratios of 1000 or more per 100 000 live births. There are also large disparities within countries, between people with high and low income and between people living in rural and urban areas. The risk of maternal mortality is highest for adolescent girls under 15 years old.1, 2 Complications in pregnancy and childbirth are the leading cause of death among adolescent girls in most developing countries.1, 2 Women in developing countries have on average many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is higher. A woman’s lifetime risk of maternal death – the probability that a 15 year old woman will eventually die from a maternal cause – is 1 in 3800 in developed countries, versus 1 in 150 in developing countries. Why do women die? 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 (mostly bleeding after childbirth) • infections (usually after childbirth) • high blood pressure during pregnancy (pre- eclampsia and eclampsia) • unsafe abortion. The remainder are caused by or associated with diseases such as malaria, and AIDS during pregnancy. Maternal health and newborn health are closely linked. Nearly three million newborn babies die every year, and an additional 2.6 million babies are stillborn.3 How can women’s lives be saved? Most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. All women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death. Severe bleeding after birth can kill a healthy woman within two hours if she is unattended. Injecting oxytocin immediately after childbirth effectively reduces the risk of bleeding. Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of infection are recognized and treated in a timely manner. Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia. To avoid maternal deaths, it is also vital to prevent unwanted and too-early pregnancies. All women, including adolescents, need access to family planning, safe abortion services to the full extent of the law, and quality post-abortion care. Why do women not get the care they need? Poor women in remote areas are the least likely to receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. While levels of antenatal care have increased in many parts of the world during the past decade, only 46% of women in low-income countries benefit from skilled care during childbirth. This means that millions of births are not assisted by a midwife, a doctor or a trained nurse. In high-income countries, virtually all women have at least four antenatal care visits, are attended by a skilled health worker during childbirth and receive postpartum care. In low-income countries, just over a third of all pregnant women have the recommended four antenatal care visits. Other factors that prevent women from receiving or seeking care during pregnancy and childbirth are: • poverty • distance • lack of information • inadequate services • cultural practices. To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. WHO response Improving maternal health is one of WHO’s key priorities. WHO is working to reduce maternal mortality by providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States. In addition, WHO advocates for more affordable and effective treatments, designs training materials and guidelines for health workers, and supports countries to implement policies and programmes and monitor progress. During the United Nations MDG summit in September 2010, UN Secretary-General Ban Ki-moon launched a Global strategy for women’s and children’s health, aimed at saving the lives of more than 16 million women and children over the next four years. WHO is working with partners towards this goal. 1. Conde-Agudelo A, Belizan JM, Lammers C. Maternal- perinatal morbidity and mortality associated with adolescent pregnancy in Latin America: Cross-sectional study. American Journal of Obstetrics and Gynecology, 2004. 192:342–349. 2. Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet, 2009, 374:881–892. 3. Cousens S, Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, Creanga AA, Tunçalp O, Balsara ZP, Gupta S, Say L, Lawn JE. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: a systematic analysis. Lancet, 2011, Apr 16;377(9774):1319- 30. Photo: Photoshare/Valerie Caldas WHO/RHR/14.06 © World Health Organization 2014 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published materi- al is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. For more information, please contact: Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27, Switzerland E-mail: reproductivehealth@who.int www.who.int/reproductivehealth