Child birth is supposed to be a beautiful thing, a happy moment as a new life is brought into the world. But in most low and middle income countries, child birth is a matter of life and death both for the mother and the child she is carrying. When a woman goes into labour, the family is not celebrating; rather they wait anxiously to hear the outcome. Did she manage to deliver the baby; are both the mother and child alive and well? When the answers to all these questions are positive then the family can celebrate. Complications due to child births have claimed lives of many women and have left many babies orphaned at birth. The statistics on maternal and neonatal deaths vary between countries and regions with sub -Saharan Africa most affected.
More than half of maternal deaths occur in Sub Saharan Africa, a third in South East Asia and more than half of the deaths occur in fragile and humanitarian settings
More than half of maternal deaths occur in Sub Saharan Africa, a third in South East Asia and more than half of the deaths occur in fragile and humanitarian settings (Alkema et al., 2016).
Despite a 44% reduction of the global maternal mortality ratio between 1990 -2015 ( http://data.worldbank.org/indicator/SH.STA.MMRT?end=2015&start=1990&view=chart), there are still many women dying due to complications from pregnancy and child birth ( http://data.worldbank.org/indicator/SH.MMR.DTHS ). The top twenty countries with the highest mortality are in sub-Saharan Africa (Table 1, Figure 1) .
The maternal mortality ratio in developing countries in 2015 was 239 per 100 000 live births versus 12 per 100 000 live births in developed countries
The maternal mortality ratio in developing countries in 2015 was 239 per 100 000 live births versus 12 per 100 000 live births in developed countries. There are several factors that have contributed to these disparities not only between developed and developing countries but also within the individual countries; between the rich and the poor, and urban and rural populations (Alkema et al., 2016).
Table 1: Trends in estimates of maternal mortality ratio (MMR; maternal deaths per 100,000 live births) 1990-2015; Twenty Countries with the Highest Mortalities
|Central African Republic||1290||1300||1200||1060||909||882|
|Democratic Republic of the Congo||879||914||874||787||794||693|
Source: WHO, UNICEF, UNFPA, World Bank Group and UNPD (MMEIG) - November 2015
There are several factors that have contributed to these disparities not only between developed and developing countries but also within the individual countries; between the rich and the poor, urban and rural populations
There are several factors that contribute to maternal mortality, these include;
- Political stability and governance: civil unrest and poor governance has contributed to substandard healthcare and weak healthcare systems. As such the health of the pregnant woman and her pregnancy are poorly monitored; and complications are only discovered too late with no planned or poor interventions .
- Economic stability : Limited resources have resulted in mediocre health services, due to lack of equipment, medicines and well trained staff in the available health facilities.
- Access to healthcare: Most rural populations have limited maternal and newborn services. This is partly due to lack of infrastructure required to:
- Provide essential Interventions for normal and routine healthcare services
- Offer emergency care
- Ignoring the needs of most rural health facilities and the affected rural communities.
- Some of the underlying beliefs and socio-cultural factors have been attributed as contributing factor to some of complications associated with child birth in sub-Saharan Africa. These Include: early marriages, rural dwelling, female circumcision, education status, unskilled birth attendants and physical violence during pregnancy (Gebrezgi, Trepka, & Kidane, 2017)
Despite all these, a reduction in maternal mortality has been observed between 1990- 2015 (Figure 1).
Figure -1: Reduction in Maternal mortality between 1990 and 2015
Source: World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 1990 to 2015, WHO, Geneva, 2015.
According to WHO the following are the Key facts
Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth, 99% of all maternal deaths occur in developing countries, Maternal mortality is higher in women living in rural areas and among poorer communities
- Every day, approximately 830 women die from preventable causes related to pregnancy and childbirth.
- 99% of all maternal deaths occur in developing countries.
- Maternal mortality is higher in women living in rural areas and among poorer communities.
- Young adolescents face a higher risk of complications and death as a result of pregnancy than other women.
- Skilled care before, during and after childbirth can save the lives of women and newborn babies.
- Between 1990 and 2015, maternal mortality worldwide dropped by about 44%.
- Between 2016 and 2030, as part of the Sustainable Development Goals, the target is to reduce the global maternal mortality ratio to less than 70 per 100 000 live births
What are the situations in some of the low and middle income countries?
Between 1990 and 2015, most of the countries with the highest maternal Mortality have gone through economic hardships, political unrest,and other humanitarian situations.
in 2015, approximately 303 000 women died during and following pregnancy and childbirth with almost all of these deaths occurring in low-resource settings. With the right interventions , most of these deaths could have been prevented ( Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group).
Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A.-B., & Gemmill, A. (2016). Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet, 387, 462–474. http://doi.org/10.1016/S0140-6736(15)00838-7
Gebrezgi, M. T., Trepka, M. J., & Kidane, E. A. (n.d.). Barriers to and facilitators of hypertension management in Asmara, Eritrea: patients’ perspectives. http://doi.org/10.1186/s41043-017-0090-4