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Maternal Health
COMMON CAUSES. WHO defines maternal mortality
as “the death of a woman while pregnant or within
42 days of termination of pregnancy, irrespective of
the duration or site of the pregnancy, from any cause
related to or aggravated by the pregnancy or its management,
but not from accidental or incidental causes.” (12)
The causes of maternal death are remarkably consistent
around the world.(13) Some 80 per cent are due
to direct obstetric complications: haemorrhage, sepsis,
complications of abortion, pre-eclampsia and eclampsia,
and prolonged/obstructed labour. About 20 per cent
of deaths have indirect causes, generally existing
medical conditions that are aggravated by pregnancy
or delivery. These include anaemia, malaria, hepatitis
and, increasingly, AIDS.
VAST GAP IN IMPACTS. But huge differences—up to a
hundred-fold—exist in the risk of pregnancy between
women in rich and poor countries, the highest differential
of any public health indicator monitored by
WHO. The lifetime risk that a woman in West Africa
will die in pregnancy or childbirth is 1 in 12. In developed
regions, the comparable risk is 1 in 4,000.(14)
Within countries, poverty dramatically increases
a woman’s chances of dying during or soon after
pregnancy.(15) Indeed, alarming gaps exist in many
countries between wealthier and poorer women and
safe motherhood care. In Bangladesh, Chad, Nepal
and the Niger, elite populations have high rates of
skilled attendance while for almost all other women
giving birth with a skilled attendant is a rarity
(national rates of skilled attendance in these countries
are among the lowest in the world). In other
countries where rates of skilled attendance are fairly
high, including Brazil, Turkey and Viet Nam, the
poorest women are still the least likely to receive
such care.(16)
Because they receive prompt and effective treatment,
women in the developed world rarely die or
experience permanent disabilities from pregnancyrelated
problems.
THE “THREE DELAYS”. In the process of home deliveries,
experts have classified the underlying causes of
maternal mortality according to the “three delays” model: delay in deciding to seek medical care; delay
in reaching appropriate care; and delay in receiving
care at health facilities.
The first delay stems from a failure to recognize
danger signs. This is usually a consequence of the
absence of skilled birth attendants, but it may also
stem from reluctance within the family or community
to send the woman to a care facility due to financial
or cultural constraints.
The second delay is caused by a lack of access to a
referral health facility, a lack of available transport
or a lack of awareness of existing services. The third
delay relates to problems in the referral facility
(including inadequate equipment or a lack of
trained personnel, emergency medicines or blood).
This is why maternal mortality reduction programmes
should give priority to the availability,
accessibility and quality of obstetric facilities.
All countries that have reduced maternal mortality
have done it through a dramatic increase in hospital
deliveries.
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