Some 350,000 women die each year during pregnancy or soon after giving birth, with women in sub-Saharan Africa, Pakistan and Afghanistan facing the highest risks. Although global rates of maternal death have been dropping by about 1.5 percent each year since 1980, there is still a long way to go if countries hope to meet United Nations Millennium Development Goal (MDG) 5 by 2015—a 75 percent reduction in the number of maternal deaths per 100,000 live births from 1990 levels. Today, an average of 251 women die per 100,000 births, and only 23 countries are on track to reach the MDG, with some countries even moving in the wrong direction.

Approximately 15 percent of women everywhere develop pregnancy complications. These include infections (such as HIV), pregnancy-induced hypertension, obstructed labor and hemorrhage. Most can be managed with proper care, but many women simply do not receive it. "It's not that you require a scientific breakthrough to solve these situations—in developed countries the knowledge and technical tools have been available to women for many, many years," says Ana Langer, coordinator of the Dean's Special Initiative on Women and Health at the Harvard School of Public Health. In many places, however, "women do not have access to them."

In Africa, for instance, women often have to rely on the willingness of others to get obstetric care because of their low social status. "For women to have timely access to services that can help to save her life she still needs the community, husband and family to be able to provide access and transportation," explains Grace Kodindo, an assistant clinical professor of population and family health at Columbia University's Mailman School of Public Health.

Possibly as a result of these societal barriers, since 1980 the Ivory Coast and Zimbabwe have both experienced increases in maternal mortality rates—in Zimbabwe deaths have jumped by 5.5 percent each year in the past two decades, in part because of low female social status and ongoing political conflict. But even the wealthiest countries face problems in maternal health, including the U.S., where 17 women die per 100,000 live births. Inequalities, however, still leave the poorest and least educated women at the greatest risk. "The context may be different, but the bottom line is the same—they don't have timely access to care," Langer says.

Whereas maternal care seems to generally be improving—albeit slowly—statistics on women who die during pregnancy are notoriously fuzzy. Record-keeping is often poor, in part because many women die in their homes rather than in clinics—and even when deaths are noted pregnancy status is not always referenced. According to Kodindo, health care workers are sometimes afraid to report maternal deaths because they believe the information will be held against them. Governments need to "inform the community that the data will be used to improve the health system," she says, not to assign blame. In addition, some deaths that occur during pregnancy are not attributable to it, although records do not always reflect the distinction. Ultimately, it is unclear just how much trust researchers should put in the numbers when assessing progress in improving maternal health.

Researchers are confident, however, about which interventions help the most. Assisted delivery comes out on top because most pregnancy deaths, irrespective of region, occur during labor. "There are still many parts of the world where the mode of delivery is the home, and it's difficult to really deal with emergencies in that setting," says Robert Black, a professor of international health at the Johns Hopkins Bloomberg School of Public Health. If women cannot get to a clinic, they should be accompanied at home by a skilled attendant, he notes.

Another part of the goal is to ensure that women everywhere have access to family planning services, as this reduces the number of unplanned and potentially complicated pregnancies—especially in adolescent and older women. "If family planning reduces the high-risk, high-parity women who have had many children and are at higher risk of death, then certainly it should reduce the maternal mortality ratio," Black says. Such services would also prevent deaths associated with unsafe abortions, which, according to a 2009 editorial published in The Lancet, kill eight women around the world every hour.

Ultimately, three quarters of gestation-related complications are treatable, Kodindo says, but the risks linger in part because many governments have been slow to prioritize maternal health. The number of maternal deaths per 100,000 live births simply has not fallen by the targeted 5.5 percent each year, so most low-income countries are unlikely to reach the MDG target. But experts remain cautiously optimistic. "I hope that in 2015 there will be an assessment of progress and a commitment to make further progress," Black says. "After all, the 2015 targets, even if achieved, are not by any means the lowest possible mortality levels. Substantial effort will still be needed."

3 Comments

1. 1. pradhangeorge 01:48 PM 9/23/10

   Dears:"But even the wealthiest countries face problems in maternal health, including the U.S., where 17 women die per 100,000 live births." This is surprising to me,India. Very simple routines, taught to traditional birth attendants, local dais,housewife helpers,even illiterate women,and prePlanning access in emergency to the nearest Midwife will help a lot.# a pregnant woman MUST be seen by an Obs, within 6-7 weeks,to ruleout Ectopic.Same visit the general total body check is made, including adequacy of the pelvis and blood factors.# Fer ,injs TT, an antenatal card,etc are started , whether followed up or not.# Water log body, head ache, will lead to check albumin and BP, and ADVISED reg tox.ofPreg.# during all the 40 weeks, any problem has to be taken care of by the relatives taking to a center.# at 36-38 weeks the relatives are taught to feel for the baby head which shd be down and central# if to a side or up, then plan delivery in Hospital.# preg women are intelligent, for they manufacture the 3kg baby inside them with all nutrition from their own food.# 40 weeks is enuf time to teach the woman and all the attendants..# deaths during and after delivery are prevented by alert staff in the labor room and immediate postDelivery.# finally if the preg. is 8th or 10th, then how CAN you manage....yes by careful anticipation.
   # You CAN bring down the M & Ch deaths by simple education and follow up.# simply said? YES and quite possible to implement.
   
   

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2. 2. pradhangeorge 02:04 PM 9/23/10

   # therefore dears, Education of everyone reg health all all aspects, preventive, curative, diagnostic,palliative,psych, shd be made a must in elementary school on,in ONE text lifelong reference book.... and not on the many many books by experts on each and every health subject.=george pradhan,mbbs/1950/ind.....Vietnam 1969-74,, Zambia 1979-88...etc. on..........

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3. 3. JaneRoberts 11:14 PM 10/1/10

   For a relatively short article this was extremely conprehensive and well done. I first met Grace Kodindo in 2007 when she presented a video "Dead Mums Don't Cry" at the first Women Deliver conference in London called to bring the world's attention to maternal mortality. Ana Langer is the immediate past president of Engenderhealth www.engenderhealth.org an American NGO which under her leadership was innovative and dedicated to bringing reproductive health to the world's most vulnerable women. If you visit www.un.org/millenniumgoals and click on Number 5 (Improve Maternal Health) you will see that under Target 2 it says "An unmet need for family planning undermines the achievement of several other goals." I would say all of them. You can not cut poverty in half, empower girls and women with education, reduce child mortality and sustain the environment without allowing women to control their fertility. Access to family planning has been promised in human rights documents and is incredibly cost effective in improving the lives of people. Unfortunately the world has fallen short of these commitments. I believe the underlying cause of this dereliction of duty is gender inequality. The poorest countries where population is exploding, and where education, health, and sanitation are lacking, and where political instability reigns, are all countries where women have low status, and often where corruption is rampant and where patriarchal religion holds sway.
   When the Bush Administration withheld $34 million from the United Nations Population Fund (UNFPA) in 2002, I started asking 34 million Americans to take a stand for the women of the world with at least one dollar. This wonderful grassroots www.34millionfriends.org is still going strong. When the world takes care of women, women take care of the world. Thank you Melinda Wenner Moyer and Scientific American for this article.

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