Maternal mortality can be avoided
May 09, 2007
MATERNAL mortality is defined as death of a mother because of pregnancy related causes. More than 500,000 mothers die per year globally, of which 98% is in developing countries. Maternal mortality ratio in Uganda is 505 per 100,000 live births. This means 6,000 pregnant women die per year in Uganda
By Dr. Hassan Mohtashami
MATERNAL mortality is defined as death of a mother because of pregnancy related causes. More than 500,000 mothers die per year globally, of which 98% is in developing countries. Maternal mortality ratio in Uganda is 505 per 100,000 live births. This means 6,000 pregnant women die per year in Uganda just because of pregnancy-related causes; about 16 mothers’ deaths per day.
Almost all these deaths could be prevented, because the main complications that may lead to death are all manageable: haemorrhage, sepsis, hypertension and obstructed labour. All pregnancies, with no exception, are at random risk for these complications and around 15% of pregnancies may end up with these problems. A delay in seeking care or in access to care or in provision of care may simply result in death of the mother.
Maternal mortality can be halved in seven to 10 years if political commitment and required resources are available. There is evidence that reduction of maternal mortality is affordable in all countries, regardless of income level and growth rate.
Care during pregnancy can improve maternal health but has limited impact on reduction of maternal mortality, because simply some of the complications are unpredictable and mostly happen around the delivery time. Health professionals try to detect high risk pregnancies during the antenatal care, but 90% of women who are identified as “high risk†during pregnancy will have normal delivery and in contrast 71% of obstructed labour occur among women in “low risk†group. Antenatal care, however, can be crucial for reduction of maternal mortality, only if a “birth plan†is prepared with the help of a health professional. A good “birth plan†includes all elements and steps that a pregnant mother and her family should know in case of a complication/emergency, such as where to go, mode of transport, costs, and others.
Human knowledge has identified three major interventions that can certainly prevent the death of a mother because of pregnancy, including: birth spacing, skilled attendance at birth and emergency obstetric care. To ensure these interventions are in place and functioning, political commitment and continuous monitoring are crucial.
The role of birth spacing in reducing mothers’ deaths is very clear and simple: the less number of pregnancies and the more space between pregnancies, the less chance to die because of pregnancy. A mother’s body needs to have recovered from the previous pregnancy to be strong and ready for the next one. This will need at least three years interval between the pregnancies. Mothers younger than 18 and older than 35 stand a higher risk of complications.
Skilled attendant at birth refers exclusively to people with midwifery skills (doctors, midwives, nurse-midwives) who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage or refer obstetric complications. They are also able to perform life-saving interventions to save a mother’s life prior to the referral. This category of health professional needs special training, that is, at least 18 months university training. Traditional birth attendants (TBAs) are not considered as skilled birth attendants and several studies have shown that they cannot contribute in reduction of maternal mortality. In a joint statement in 1999, WHO, World Bank, UNICEF and UNFPA stated that, “Training of TBAs, in the absence of back-up from a functioning referral system and support from professionally trained health workers (skilled attendants at birth), is not effective in reducing maternal mortality.â€
Emergency obstetric care units are required in case of an emergency that may need higher level of professional health care, such as an obstructed labour that need caesarean section. These units should be easily accessible to all mothers and be equipped with required manpower and instruments to save the lives of the referred pregnant mothers.
The writer is the Deputy Representative (Officer in Charge) of the UNFPA
MATERNAL mortality is defined as death of a mother because of pregnancy related causes. More than 500,000 mothers die per year globally, of which 98% is in developing countries. Maternal mortality ratio in Uganda is 505 per 100,000 live births. This means 6,000 pregnant women die per year in Uganda just because of pregnancy-related causes; about 16 mothers’ deaths per day.
Almost all these deaths could be prevented, because the main complications that may lead to death are all manageable: haemorrhage, sepsis, hypertension and obstructed labour. All pregnancies, with no exception, are at random risk for these complications and around 15% of pregnancies may end up with these problems. A delay in seeking care or in access to care or in provision of care may simply result in death of the mother.
Maternal mortality can be halved in seven to 10 years if political commitment and required resources are available. There is evidence that reduction of maternal mortality is affordable in all countries, regardless of income level and growth rate.
Care during pregnancy can improve maternal health but has limited impact on reduction of maternal mortality, because simply some of the complications are unpredictable and mostly happen around the delivery time. Health professionals try to detect high risk pregnancies during the antenatal care, but 90% of women who are identified as “high risk†during pregnancy will have normal delivery and in contrast 71% of obstructed labour occur among women in “low risk†group. Antenatal care, however, can be crucial for reduction of maternal mortality, only if a “birth plan†is prepared with the help of a health professional. A good “birth plan†includes all elements and steps that a pregnant mother and her family should know in case of a complication/emergency, such as where to go, mode of transport, costs, and others.
Human knowledge has identified three major interventions that can certainly prevent the death of a mother because of pregnancy, including: birth spacing, skilled attendance at birth and emergency obstetric care. To ensure these interventions are in place and functioning, political commitment and continuous monitoring are crucial.
The role of birth spacing in reducing mothers’ deaths is very clear and simple: the less number of pregnancies and the more space between pregnancies, the less chance to die because of pregnancy. A mother’s body needs to have recovered from the previous pregnancy to be strong and ready for the next one. This will need at least three years interval between the pregnancies. Mothers younger than 18 and older than 35 stand a higher risk of complications.
Skilled attendant at birth refers exclusively to people with midwifery skills (doctors, midwives, nurse-midwives) who have been trained to proficiency in the skills necessary to manage normal deliveries and diagnose, manage or refer obstetric complications. They are also able to perform life-saving interventions to save a mother’s life prior to the referral. This category of health professional needs special training, that is, at least 18 months university training. Traditional birth attendants (TBAs) are not considered as skilled birth attendants and several studies have shown that they cannot contribute in reduction of maternal mortality. In a joint statement in 1999, WHO, World Bank, UNICEF and UNFPA stated that, “Training of TBAs, in the absence of back-up from a functioning referral system and support from professionally trained health workers (skilled attendants at birth), is not effective in reducing maternal mortality.â€
Emergency obstetric care units are required in case of an emergency that may need higher level of professional health care, such as an obstructed labour that need caesarean section. These units should be easily accessible to all mothers and be equipped with required manpower and instruments to save the lives of the referred pregnant mothers.
The writer is the Deputy Representative (Officer in Charge) of the UNFPA