Why do women still die giving birth?

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Every other minute, a woman or girl dies as a result of pregnancy complications or childbirth. Why has the global decline in maternal mortality stalled?

How many women die in childbirth?

According to the latest UN global estimates, 303,000 women a year die in childbirth, or as a result of complications arising from pregnancy. This equates to about 830 women dying each day – roughly one every two minutes.

The majority of deaths are from conditions that could have been prevented had women received the right medical care throughout their pregnancies and during birth. Severe bleeding and infections after childbirth are the biggest killers, but high blood pressure, obstructed labour and unsafe abortions all contribute.

Accurate maternal mortality figures require strong in-country data collection, which is often unavailable in developing countries, so the number of deaths is likely to be underreported.

Where do the deaths occur?

The overwhelming majority of maternal deaths occur in developing countries. About two-thirds of all maternal deaths take place in sub-Saharan Africa. Nigeria and India alone account for one-third of global deaths.

The maternal mortality ratio in the world’s least developed countries stands at 436 deaths for every 100,000 live births, which is in stark contrast to the corresponding number – just 12 – in wealthy countries.

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A pregnant woman suffers complications in Freetown’s Kroo Bay clinic. Sierra Leone had the world’s highest maternal mortality rate in 2015. Photograph: Lee Karen Stow/Alamy

World Bank figures show that in 2015 (the latest year for which there are records) Sierra Leone had the highest maternal mortality ratio in the world, with 1,360 deaths for every 100,000 live births – although this represents a 50% reduction since 1990.

What progress has been made to reduce deaths?

Despite the number of deaths, global figures reflect progress. In 1990 an estimated 532,000 women died annually, so there has been a 44% drop in a generation.

But while the reduction certainly merits celebration, it reflects a small return on big global commitments. At the first world conference on women, held in Mexico in 1975, a spotlight was shone on the high number of maternal deaths, and action urged to reduce them. In 1994, 179 governments at the international conference on population and development in Cairo made a joint promise that, by the turn of the century, they would halve the number of maternal deaths recorded in 1990, and then halve the figure again by 2015. This didn’t happen.

mortality rate chart
10 worst chart

In 2001, UN member states agreed the millennium development goals, which included a call for the number of maternal deaths to be cut by three-quarters by 2015. While the MDGs boosted efforts, the goal was not met in the countries with the highest death rates. In fact, it was the target that made the slowest progress. According to the World Health Organization (WHO), between 1990 and 2005, maternal mortality rates decreased by an average of 2.3% a year – way below the 5.5% needed to achieve the MDGs. And now the decline seems to have plateaued.

Sara,
‘It wasn’t an easy experience’: Sara, a mother in Lilongwe, gave birth to her son in March 2016. Malawi has many young mothers. Photograph: Unicef/Chikondi

Why has the figure plateaued?

When there is a high death rate, relatively simple interventions – raising awareness among women of the importance of seeking medical attention during pregnancy and childbirth, training local community health workers to spot signs of problems in labour – will bring fairly quick wins.

But moving the needle much further requires greater political will and more money, says Anneka Knutsson, chief of sexual and reproductive health at the UN population fund (UNFPA). “Any intervention that brings women to a health centre to have antenatal care, informs women of the importance of seeking care, or decreases the number of home births done alone, will have a great impact,” she says. “When you get to the level of about 200 deaths [for every 100,000 live births] there are so many more interventions that need to be in place in the health system to reduce it further. These relate to competent staff in place, and facilities that, in addition to safe normal deliveries, can provide blood transfusion, C-section or other types of assisted deliveries. It requires more long-term and complex investments in the health system. This is one reason why the pace of decrease slows down.”

Why are women dying?

There are a number of reasons, and they are rooted in poverty, inequality and sexism. The majority of women die in poorer, rural areas, where healthcare services are often inadequate or inaccessible, and where there is a severe shortage of trained medical staff. Women from such areas are less likely to give birth with a skilled health worker than wealthier women.

Read more: www.theguardian.com

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