The world has seen tremendous progress towards the goal of reducing maternal mortality, especially during the past decade.

"Ensuring access to high-quality health services during pregnancy and childbirth is crucial to save lives."

Despite such progress, nearly 300,000 women continue to die each year from complications of pregnancy and childbirth, the vast majority in developing countries. Most deaths are preventable.

All women should have access to essential health interventions such as:

  • injecting oxytocin immediately after childbirth to reduce the risk of severe bleeding;
  • identifying and addressing potentially fatal conditions like pregnancy-induced hypertension;
  • good hygiene during childbirth to reduce the risk of infection;
  • ensuring access to sexual and reproductive health services and family planning for women.
 

Care should be available to all

 

Good quality pregnancy and childbirth care should be available and accessible to all women regardless of their ability to pay for services.

Efforts in expanding the reach of health care should be coupled with those that address broader determinants such as improving education for girls and women.

"Education provides mothers with the knowledge to challenge traditional practices that endanger them and their children."

In wealthy countries over-medicalisation of birth is also a problem. Excessive use of medical interventions is associated with private practice, medico-legal pressure and when women have less of a voice in birthing decisions. A good midwife in a birthing centre with access to speedy obstetric referral is an ideal option for dignified care. 

 

Access to care and education should be available to all mothers and babies, despite their ability to pay. Photo credits: UNAIDS


 

Keeping track of deaths

 

An important component of successful prevention is to accurately identify the frequency and causes of deaths – both the clinical conditions that cause them and the wider circumstances that contribute to them.

In many instances, without an established measurement and monitoring system, maternal deaths may not be identified correctly. The death of a woman due to complications related to pregnancy may be missed from maternal mortality statistics if her pregnancy status is not known. Or the cause of a death may be wrongly assigned. Such missing and inaccurate data and statistics misinforms the actions required to reduce and eliminate deaths.

"Maternal death audits and reviews help us to prevent similar deaths."

Recently, increasing attention has been paid to strengthening data collection. Accurate civil and vital registration systems that include births, deaths and correct identification of causes of death are a priority. These systems should be complemented with maternal death audits and reviews to understand why, where and when women die and what can be done to prevent similar deaths.

 

What is happening in the UK?

 

In the UK, the system of Confidential Enquiries in Maternal Deaths introduced in 1952, was a key element in reducing deaths of mothers: from 90 per 100,000 women giving birth in 1952, to around 10 per 100,000 at present.

Maternal Death Surveillance and Response is a more recent World Health Organization (WHO) strategy that supports identification and timely notification of all maternal deaths, followed by a review of their causes and contributory factors and the best methods of prevention. An increasing number of low- and middle-income countries are now implementing these approaches, which should contribute to accelerated progress in survival of mothers with the right investment if implemented systematically and at scale.