WUNRN
http://www.who.int/mediacentre/factsheets/fs348/en/
Maternal Mortality
Fact Sheet N°348 -
Updated May 2014
Key Facts
Maternal mortality
is unacceptably high. About 800 women die from pregnancy- or childbirth-related
complications around the world every day. In 2013, 289 000 women died
during and following pregnancy and childbirth. Almost all of these deaths
occurred in low-resource settings, and most could have been prevented.
Progress towards
achieving the fifth Millennium Development Goal
Improving maternal
health is 1 of the 8 Millennium Development Goals (MDGs) adopted by the
international community in 2000. Under MDG5, countries committed to reducing
maternal mortality by three quarters between 1990 and 2015. Since 1990, maternal
deaths worldwide have dropped by 45%.
In sub-Saharan
Africa, a number of countries have halved their levels of maternal mortality
since 1990. In other regions, including Asia and North Africa, even greater
headway has been made. However, between 1990 and 2013, the global maternal
mortality ratio (i.e. the number of maternal deaths per 100 000 live
births) declined by only 2.6% per year. This is far from the annual decline of
5.5% required to achieve MDG5.
Where do maternal
deaths occur?
The high number of
maternal deaths in some areas of the world reflects inequities in access to
health services, and highlights the gap between rich and poor. Almost all
maternal deaths (99%) occur in developing countries. More than half of these
deaths occur in sub-Saharan Africa and almost one third occur in South Asia.
The maternal
mortality ratio in developing countries in 2013 is 230 per 100 000 live
births versus 16 per 100 000 live births in developed countries. There are
large disparities between countries, with few countries having extremely high
maternal mortality ratios around 1000 per 100 000 live births. There are
also large disparities within countries, between women with high and low income
and between women living in rural and urban areas.
The risk of maternal
mortality is highest for adolescent girls under 15 years old and complications
in pregnancy and childbirth are the leading cause of death among adolescent
girls in developing countries.1, 2
Women in
developing countries have on average many more pregnancies than women in
developed countries, and their lifetime risk of death due to pregnancy is
higher. A woman’s lifetime risk of maternal death – the probability that a 15
year old woman will eventually die from a maternal cause – is 1 in 3700 in
developed countries, versus 1 in 160 in developing countries.
Why do women die?
Women die as a
result of complications during and following pregnancy and childbirth. Most of
these complications develop during pregnancy. Other complications may exist
before pregnancy but are worsened during pregnancy. The major complications
that account for nearly 75% of all maternal deaths are:
The remainder are
caused by or associated with diseases such as malaria, and AIDS during
pregnancy.
Maternal health
and newborn health are closely linked. Almost 3 million newborn babies die
every year4, and an additional 2.6 million babies are stillborn.5
How can women’s
lives be saved?
Most maternal
deaths are preventable, as the health-care solutions to prevent or manage
complications are well known. All women need access to antenatal care in
pregnancy, skilled care during childbirth, and care and support in the weeks
after childbirth. It is particularly important that all births are attended by
skilled health professionals, as timely management and treatment can make the
difference between life and death.
Severe bleeding after birth can
kill a healthy woman within hours if she is unattended. Injecting oxytocin
immediately after childbirth effectively reduces the risk of bleeding.
Infection after childbirth
can be eliminated if good hygiene is practiced and if early signs of infection
are recognized and treated in a timely manner.
Pre-eclampsia should be
detected and appropriately managed before the onset of convulsions (eclampsia)
and other life-threatening complications. Administering drugs such as magnesium
sulfate for pre-eclampsia can lower a woman’s risk of developing eclampsia.
To avoid maternal
deaths, it is also vital to prevent unwanted and too-early pregnancies. All
women, including adolescents, need access to contraception, safe abortion
services to the full extent of the law, and quality post-abortion care.
Why do women not
get the care they need?
Poor women in
remote areas are the least likely to receive adequate health care. This is
especially true for regions with low numbers of skilled health workers, such as
sub-Saharan Africa and South Asia. While levels of antenatal care have
increased in many parts of the world during the past decade, only 46% of women
in low-income countries benefit from skilled care during childbirth6.
This means that millions of births are not assisted by a midwife, a doctor or a
trained nurse.
In high-income
countries, virtually all women have at least 4 antenatal care visits, are
attended by a skilled health worker during childbirth and receive postpartum
care. In low-income countries, just over a third of all pregnant women have the
recommended 4 antenatal care visits.
Other factors that
prevent women from receiving or seeking care during pregnancy and childbirth
are:
To improve
maternal health, barriers that limit access to quality maternal health services
must be identified and addressed at all levels of the health system.
WHO response
Improving maternal
health is one of WHO’s key priorities. WHO is working to reduce maternal
mortality by providing evidence-based clinical and programmatic guidance,
setting global standards, and providing technical support to Member States.
In addition, WHO
advocates for more affordable and effective treatments, designs training materials
and guidelines for health workers, and supports countries to implement policies
and programmes and monitor progress.
During the United
Nations MDG summit in September 2010, UN Secretary-General Ban Ki-moon launched
a Global strategy for women's and children's health, aimed at saving the
lives of more than 16 million women and children over the next 4 years. WHO is
working with partners towards this goal7.
1Conde-Agudelo A,
Belizan JM, Lammers C. Maternal-perinatal morbidity and mortality associated
with adolescent pregnancy in Latin America: Cross-sectional study. American
Journal of Obstetrics and Gynecology, 2004, 192:342–349.
2 Patton GC, Coffey
C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD.
Global patterns of mortality in young people: a systematic analysis of
population health data. Lancet, 2009, 374:881–892.
3 Say L et al.
Global Causes of Maternal Death: A WHO Systematic Analysis. Lancet.
2014.
4 UNICEF, WHO, The
World Bank, United Nations Population Division. The Inter-agency Group for
Child Mortality Estimation (UN IGME). Levels and Trends in Child Mortality.
Report 2013. New York, USA, UNICEF, 2013.
5 Cousens S,
Blencowe H, Stanton C, Chou D, Ahmed S, Steinhardt L, Creanga AA, Tunçalp O,
Balsara ZP, Gupta S, Say L, Lawn JE. National, regional, and worldwide
estimates of stillbirth rates in 2009 with trends since 1995: a systematic
analysis. Lancet, 2011, Apr 16, 377(9774):1319-30. [in press, will be
published 15 May 2014]
6 WHO. World
Health Statistics 2014. Geneva, World Health Organization; 2014.
7 Ban K. The
Global Strategy for Women’s and Children’s Health. New York, NY, USA,
United Nations, 2010.