UNFPAState of World Population 2004
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HOME: STATE OF WORLD POPULATION 2004: Maternal Health
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Maternal Health

New Approaches
Causes and Consequences
Maternal Morbidity
Obstetric Fistula
Reducing Maternal Mortality and Morbidity
Difficulties in Measurement
Holistic Responses
Antenatal Care
Skilled Attendance
Emergency Obstetric Care
Post-abortion Care
Quality of Maternal Health
Men and Maternal Health
UNFPA and Safe Motherhood

Causes and Consequences

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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