Maternal death or maternal mortality is defined in slightly different ways by several different health organizations. The World Health Organization (WHO) defines maternal death as the death of a pregnant mother due to complications related to pregnancy , underlying conditions worsened by the pregnancy or management of these conditions. This can occur either while she is pregnant or within six weeks of resolution of the pregnancy. The CDC definition of pregnancy-related deaths extends the period of consideration to include one year from the resolution of the pregnancy. Pregnancy associated death, as defined by the American College of Obstetricians and Gynecologists (ACOG), are all deaths occurring within one year of a pregnancy resolution. Identification of pregnancy associated deaths is important for deciding whether or not the pregnancy was a direct or indirect contributing cause of the death.
53-534: There are two main measures used when talking about the rates of maternal mortality in a community or country. These are the maternal mortality ratio and maternal mortality rate, both abbreviated as "MMR". By 2017, the world maternal mortality rate had declined 44% since 1990; however, every day 808 women die from pregnancy or childbirth related causes. According to the United Nations Population Fund (UNFPA) 2017 report, about every 2 minutes
106-571: A 2004 WHO publication, sociodemographic factors such as age, access to resources and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and death during pregnancy than older mothers, especially adolescents aged 15 years or younger. Adolescents have higher risks for postpartum hemorrhage, endometritis , operative vaginal delivery , episiotomy , low birth weight , preterm delivery , and small-for-gestational-age infants, all of which can lead to maternal death. The leading cause of death for girls at
159-426: A heart problem. As women have gained access to family planning and skilled birth attendant with backup emergency obstetric care, the global maternal mortality ratio has fallen from 385 maternal deaths per 100,000 live births in 1990 to 216 deaths per 100,000 live births in 2015. Many countries halved their maternal death rates in the last 10 years. Although attempts have been made to reduce maternal mortality, there
212-497: A medical facility, lack of adequate medical facilities in the area, and lack in confidence in medicine. Delays in receiving adequate and appropriate care may result from an inadequate number of trained providers, lack of appropriate supplies, and the lack of urgency or understanding of an emergency. The three delays model illustrates that there are a multitude of complex factors, both socioeconomic and cultural, that can result in maternal death. The four measures of maternal death are
265-557: A midwife, doctor, or trained nurse), with back-up obstetric care for emergency situations that may occur during the process of labor. This can be examined further by looking at statistics in some areas of the world where inequities in access to health care services reflect an increased number of maternal deaths. The high maternal death rates also reflect disparate access to health services between resource communities and those that are high-resource or affluent. The disparities in maternal health outcomes are also present among racial groups. In
318-443: A pregnancy are termed accidental , incidental , or non-obstetrical maternal deaths. Indirect causes include malaria , anemia , HIV/AIDS , and cardiovascular disease , all of which may complicate pregnancy or be aggravated by it. Risk factors associated with increased maternal death include the age of the mother, obesity before becoming pregnant, other pre-existing chronic medical conditions, and cesarean delivery . According to
371-482: A senator, in 2019 Harris reintroduced the Maternal Care Access and Reducing Emergencies (CARE) Act which aimed to address the maternal mortality disparity faced by women of color by training providers on recognizing implicit racial bias and its impact on care. Harris stated: "We need to speak the uncomfortable truth that women—and especially Black women—are too often not listened to or taken seriously by
424-674: A wider population, with access to high-quality care, can make steps towards reducing the number of unsafe abortions. For nations that allow contraceptives, programs should be instituted to allow the easier accessibility of these medications. However, this alone will not eliminate the demand for safe services, awareness on safe abortion services, health education on prenatal check ups and proper implementation of diets during pregnancy and lactation also contributes to its prevention. Indirect obstetric deaths are caused by preexisting health problem worsened by pregnancy or newly developed health problem unrelated to pregnancy . Fatalities during but unrelated to
477-763: A woman dies because of complications due to child birth or pregnancy. For every woman who dies, there are about 20 to 30 women who experience injury, infection, or other birth or pregnancy related complication. UNFPA estimated that 303,000 women died of pregnancy or childbirth related causes in 2015. The WHO divides causes of maternal deaths into two categories: direct obstetric deaths and indirect obstetric deaths. Direct obstetric deaths are causes of death due to complications of pregnancy, birth or termination. For example, these could range from severe bleeding to obstructed labor , for which there are highly effective interventions. Indirect obstetric deaths are caused by pregnancy interfering or worsening an existing condition, like
530-428: Is a key performance indicator (KPI) for efforts to improve the health and safety of mothers before, during, and after childbirth per country worldwide. Often referred to as MMR, it is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). It is not to be confused with the maternal mortality rate , which
583-548: Is a low-technology pressure device that decreases blood loss, restores vital signs and helps buy time in delay of women receiving adequate emergency care during obstetric hemorrhage . It has proven to be a valuable resource. Condoms used as uterine tamponades have also been effective in stopping post-partum hemorrhage. Some maternal deaths can be prevented through medication use. Injectable oxytocin can be used to prevent death due to postpartum bleeding . Additionally, postpartum infections can be treated using antibiotics. In fact,
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#1732783356344636-461: Is a systematic tool that is used to collect information on the cause of death from laypeople and not medical professionals. Confidential enquires for maternal deaths do not occur very often on a national level in most countries. Registration systems are usually considered the "gold-standard" method for mortality measurements. However, they have been shown to miss anywhere between 30 and 50% of all maternal deaths. Another concern for registration systems
689-422: Is common since it is more likely to be legally restrictive and/or more highly stigmatizing. Another concern for issues related to errors in proper reporting for accurate understanding of maternal mortality is the fact that global estimates of maternal deaths related to a specific cause present those related to abortion as a proportion of the total mortality rate. Therefore, any change, whether positive or negative, in
742-459: Is contrast to high income countries, for which the most common cause is thromboembolism . Between 1990 and 2015, the maternal mortality ratio has decreased from 385 deaths per 100,000 live births to 216 maternal deaths per 100,000 live births. Some factors that have been attributed to the decreased maternal deaths seen between this period are in part to the access that women have gained to family planning services and skilled birth attendance, meaning
795-578: Is legal and accessible, it is widely regarded as safer than carrying a pregnancy to term and delivery. In fact, a study published in the journal Obstetrics & Gynecology reported that in the United States, carrying a pregnancy to term and delivering a baby comes with 14 times increased risk of death as compared to a legal abortion. However, in many regions of the world, abortion is not legal and can be unsafe. Maternal deaths caused by improperly performed procedures are preventable and contribute 13% to
848-460: Is much room for improvement, particularly in low-resource regions. Over 85% of maternal deaths are in low-resource communities in Africa and Asia. In higher resource regions, there are still significant areas with room for growth, particularly as they relate to racial and ethnic disparities and inequities in maternal mortality and morbidity rates. Overall, maternal mortality is an important marker of
901-495: Is one of the interventions proposed to reduce maternal mortality where maternal deaths are continuously reviewed to learn the causes and factors that led to the death. The information from the reviews is used to make recommendations for action to prevent future similar deaths. Maternal and perinatal death reviews have been in practice for a long time worldwide, and the World Health Organization (WHO) introduced
954-524: Is recommended that expectant mothers receive at least four antenatal visits to check and monitor the health of mother and fetus . Second, skilled birth attendance with emergency backup such as doctors, nurses and midwives who have the skills to manage normal deliveries and recognize the onset of complications. Third, emergency obstetric care to address the major causes of maternal death which are hemorrhage , sepsis , unsafe abortion, hypertensive disorders and obstructed labor . Lastly, postnatal care which
1007-482: Is safe and does not contribute greatly to overall rates of maternal death. However, in regions where abortions are not legal, available, or regulated, unsafe abortion practices can cause significant rates of maternal death. According to the World Health Organization in 2009, every eight minutes a woman died from complications arising from unsafe abortions. Unsafe abortion practices are defined by
1060-402: Is that 75% of all global births occur in countries where vital registration systems do not exist, meaning that many maternal deaths occurring during these pregnancies and deliveries may not be properly record through these methods. There are also issues with using verbal autopsies and other forms of survey in recording maternal death rates. For example, the family's willingness to participate after
1113-587: Is the number of maternal deaths (direct and indirect) in a given period per 100,000 women of reproductive age during the same time period. The statistics are gathered by WHO , UNICEF , UNFPA , World Bank Group , and the United Nations Population Division . The yearly report started in 1990 and is called Trends in Maternal Mortality . As of the 2015 data published in 2016, the countries that have seen an increase in
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#17327833563441166-437: Is the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women. Lifetime risk of maternal death is a calculated prediction of a woman's risk of death after each consecutive pregnancy. The calculation pertains to women during their reproductive years. The adult lifetime risk of maternal mortality can be derived using either the maternal mortality ratio (MMR), or
1219-424: Is the six weeks following delivery. During this time, bleeding, sepsis and hypertensive disorders can occur, and newborns are extremely vulnerable in the immediate aftermath of birth. Therefore, follow-up visits by a health worker to assess the health of both mother and child in the postnatal period is strongly recommended. Additionally, reliable access to information, compassionate counseling and quality services for
1272-407: Is uncontrollable bleeding from the uterus, cervix or vaginal wall after birth. This can happen when the uterus does not contract correctly after birth, there is left over placenta in the uterus, or there are cuts in the cervix or vagina from birth. Hypertensive disorders of pregnancy happen when the body does not regulate blood pressure correctly. In pregnancy, this is due to changes at the level of
1325-460: The Lancet which covered the period from 1990 to 2013, the most common causes of maternal death world-wide are postpartum bleeding (15%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum infections (8%), and obstructed labor (6%). Other causes include blood clots (3%) and pre-existing conditions (28%). Postpartum bleeding happens when there
1378-441: The maternal mortality ratio (MMR), maternal mortality rate, lifetime risk of maternal death and proportion of maternal deaths among deaths of women of reproductive years (PM). Maternal mortality ratio (MMR) is the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time-period. The MMR is used as a measure of the quality of a health care system. Maternal mortality rate (MMRate)
1431-556: The 2010 United Nations Population Fund report, low-resource nations account for ninety-nine percent of maternal deaths with the majority of those deaths occurring in Sub-Saharan Africa and Southern Asia. Globally, high and middle income countries experience lower maternal deaths than low income countries. The Human Development Index (HDI) accounts for between 82 and 85 percent of the maternal mortality rates among countries. In most cases, high rates of maternal deaths occur in
1484-701: The Maternal and Perinatal Death Surveillance and Response (MPDSR) with a guideline in 2013. Studies have shown that acting on recommendations from MPDSR can reduce maternal and perinatal mortality by improving quality of care in the community and health facilities. It was estimated that in 2015, a total of 303,000 women died due to causes related to pregnancy or childbirth. The majority of these were due to severe bleeding, sepsis or infections, eclampsia, obstructed labor, and consequences from unsafe abortions. Most of these causes are either preventable or have highly effective interventions. An important factor that contributes to
1537-452: The United States do not receive the recommended number of prenatal visits. This number increases for women among traditionally marginalized populations—32% of African American women and 41% for American Indian and Alaska Native women do not receive the recommended preventative health services prior to delivery. In 2023, a study reported that deaths among Native American women was three-and-a-half times that of white women. The report attributed
1590-449: The United States, as many women of older age continue to have children, the maternal mortality rate has risen in some states, especially among women over 40 years old. Structural support and family support influences maternal outcomes. Furthermore, social disadvantage and social isolation adversely affects maternal health which can lead to increases in maternal death. Additionally, lack of access to skilled medical care during childbirth ,
1643-540: The United States, black women are 3-4 times more likely to die from maternal mortality than white women. Unequal access to quality medical care, socioeconomic disparities, and systemic racism by health care providers are factors that have contributed to the high maternal mortality rates among black women. Discounting factors such as pre-existing conditions, do not impact the rate of this disparity. In 2019, Black maternal health advocate and Parents writer Christine Michel Carter interviewed Vice President Kamala Harris . As
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1696-744: The WHO as procedures that are performed by someone without the appropriate training and/or ones that are performed in an environment that is not considered safe or clean. Using this definition, the WHO estimates that out of the 45 million abortions that are performed each year globally, 19 million of these are considered unsafe, and 97% of these unsafe abortions occur in developing countries. Complications include hemorrhage, infection, sepsis and genital trauma . There are four primary types of data sources that are used to collect abortion-related maternal mortality rates: confidential enquiries, registration data, verbal autopsy, and facility-based data sources. A verbal autopsy
1749-678: The WHO as time- and cost-effective, is the sisterhood method . The United Nations Population Fund (UNFPA; formerly known as the United Nations Fund for Population Activities) have established programs that support efforts in reducing maternal death. These efforts include education and training for midwives, supporting access to emergency services in obstetric and newborn care networks, and providing essential drugs and family planning services to pregnant women or those planning to become pregnant. They also support efforts for review and response systems regarding maternal deaths. According to
1802-534: The abortion-related mortality rate is only compared relative to other causes, and this does not allow for proper implications of whether abortions are becoming more safe or less safe with respect to the overall mortality of women. The prevention and reduction of maternity death is one of the United Nations ' Sustainable Development Goals , specifically Goal 3 , "Good health and well being". Promoting effective contraceptive use and information distributed to
1855-433: The age of 15 in developing countries is complication through pregnancy and childbirth. They have more pregnancies, on average, than women in developed countries, and it has been shown that 1 in 180 15-year-old girls in developing countries who become pregnant will die due to complications during pregnancy or childbirth. This is compared to women in developed countries, where the likelihood is 1 in 4900 live births. However, in
1908-431: The blood vessels, likely because of the placenta . This includes medical conditions like gestational hypertension and pre-eclampsia . Postpartum infections are infections of the uterus or other parts of the reproductive tract after the resolution of a pregnancy. They are usually bacterial and cause fever, increased pain, and foul-smelling discharge. Obstructed labor happens when the baby does not properly move into
1961-598: The contents of the uterus can be cleaned if there is concern for remaining pregnancy tissue or infection. If there is concern for excess bleeding, special ties, stitches or tools ( Bakri Balloon ) can be placed if there is concern for excess bleeding. A public health approach to addressing maternal mortality includes gathering information on the scope of the problem, identifying key causes, and implementing interventions, both prior to pregnancy and during pregnancy, to combat those causes and prevent maternal mortality. Maternal mortality ratio The maternal mortality ratio
2014-423: The decisions made by the women who are pregnant and/or other decision-making individuals. Decision-making individuals can include a spouse and family members. Examples of reasons for delays in seeking care include lack of knowledge about when to seek care, inability to afford health care, and women needing permission from family members. Delays in reaching care include factors such as limitations in transportation to
2067-744: The government of Texas created the Maternal Mortality and Morbidity Task Force in 2013. This KPI was used for the Millennium Development Goals from 2000 to 2015 and is part of the Sustainable Development Goals . The list of countries with a comparison of this KPI in 1990, 2000 and 2015 are: Abortion Too Many Requests If you report this error to the Wikimedia System Administrators, please include
2120-832: The health care system, and therefore they are denied the dignity that they deserve. And we need to speak this truth because today, the United States is 1 of only 13 countries in the world where the rate of maternal mortality is worse than it was 25 years ago. That risk is even higher for Black women, who are three to four times more likely than white women to die from pregnancy-related causes. These numbers are simply outrageous." The Covid-19 pandemic heightened maternal mortality rates, disproportionately impacting communities of color. Multiple factors contribute to this widening disparity, notably, social factors such as implicit bias, repeated racial discrimination, and limited access to healthcare. All issues are further exacerbated for people of color who face systemic barriers to adequate medical care. Overall,
2173-401: The health of the country and reflects on its health infrastructure. Lowering the amount of maternal death is an important goal of many health organizations world-wide. Direct obstetric deaths are due to complications of pregnancy, birth, termination or complications arising from their management. The causes of maternal death vary by region and level of access. According to a study published in
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2226-718: The high rate in part to the fact that Native American women are cared for under a poorly funded Federal Health Care System that is so stretched that the average monthly visit lasts only from three to seven minutes. Such a short visit allows neither time for performing an adequate health assessment nor time for the patient to discuss any problems she may be experiencing. The decline in maternal deaths has been due largely to improved aseptic techniques , better fluid management and quicker access to blood transfusions , and better prenatal care . Technologies have been designed for resource poor settings that have been effective in reducing maternal deaths as well. The non-pneumatic anti-shock garment
2279-454: The loss of a loved one, misclassification of the cause of death, and under-reporting all present obstacles to the proper reporting of maternal mortality causes. Finally, a potential issue with facility-based data collection on maternal mortality is the likelihood that women who experience abortion-related complications to seek care in medical facilities. This is due to fear of social repercussions or legal activity in countries where unsafe abortion
2332-408: The management of any issues that arise from abortions (whether safe or unsafe) can be beneficial in reducing the number of maternal deaths. In regions where abortion is legal, abortion practices need to be safe in order to effectively reduce the number of maternal deaths related to abortion. Maternal Death Surveillance and Response is another strategy that has been used to prevent maternal death. This
2385-460: The maternal mortality rate (MMRate). Proportion of maternal deaths among deaths of women of reproductive age (PM) is the number of maternal deaths in a given time period divided by the total deaths among women aged 15–49 years. Approaches to measuring maternal mortality include civil registration system, household surveys, census , reproductive age mortality studies (RAMOS) and verbal autopsies. The most common household survey method, recommended by
2438-527: The maternal mortality rate increased from 23.8 deaths per 100,000 live births in 2020, to 32.9 deaths per 100,000 live births in 2021. An apparent spike in this rate can be noted in 2021. For non-hispanic black women the rate of maternal deaths per 100,00 live births increased from 44.0 in 2019 to 69.9 in 2021. According to UNFPA , there are four essential elements for prevention of maternal death. These include, prenatal care , assistance with birth, access to emergency obstetric care and adequate postnatal care. It
2491-399: The maternal mortality rate is access and opportunity to receive prenatal care. Women who do not receive prenatal care are between three and four times more likely to die from complications resulting from pregnancy or delivery than those who receive prenatal care. Even in high-resource countries, many women do not receive the appropriate preventative or prenatal care. For example, 25% of women in
2544-474: The maternal mortality rate worldwide. This number is increased to 25% in countries where other causes of maternal mortality are low, such as in Eastern European and South American countries. This makes unsafe abortion practices the leading cause of maternal death worldwide. Unsafe abortion is another major cause of maternal death worldwide. In regions where abortion is legal and accessible, abortion
2597-533: The maternal mortality ratio since 1990 are the Bahamas, Georgia, Guyana, Jamaica, Dem. People’s Rep. Korea, Serbia, South Africa, St. Lucia, Suriname, Tonga, United States , Venezuela, RB Zimbabwe. But according to Sustainable Development Goals report 2018, the overall maternal mortality ratio has declined by 37 percent since 2002. Nearly 303,000 women died due to complications during pregnancy. With an exceptionally high mortality ratio compared to other U.S. states,
2650-436: The pelvis and out of the body during labor. The most common cause of obstructed labor is when the baby's head is too big or angled at a way that does not allow it to pass through the pelvis and birth canal. Blood clots can occur in different vessels in the body, including vessels in the arms, legs, and lungs. They can cause problems in the lung, as well as travel to the heart or brain, leading to complications. When abortion
2703-432: The same countries that have high rates of infant mortality . These trends are a reflection that higher income countries have stronger healthcare infrastructure, more doctors, use more advanced medical technologies and have fewer barriers to accessing care than low income countries. In low income countries, the most common cause of maternal death is obstetrical hemorrhage , followed by hypertensive disorders of pregnancy. This
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#17327833563442756-954: The travel distance to the nearest clinic to receive proper care, number of prior births, barriers to accessing prenatal medical care and poor infrastructure all increase maternal deaths. Pregnancy-related deaths between 2011 and 2014 in the United States have been shown to have major contributions from non-communicable diseases and conditions, and the following are some of the more common causes related to maternal death: cardiovascular diseases (15.2%.), non-cardiovascular diseases (14.7%), infection or sepsis (12.8%), hemorrhage (11.5%), cardiomyopathy (10.3%), pulmonary embolism (9.1%), cerebrovascular accidents (7.4%), hypertensive disorders of pregnancy (6.8%), amniotic fluid embolism (5.5%), and anesthesia complications (0.3%). The three delays model describes three critical factors that inhibit women from receiving appropriate maternal health care. These factors include: Delays in seeking care are due to
2809-409: The use of broad-spectrum antibiotics both for the prevention and treatment of maternal infection is common in low-income countries. Maternal death due to eclampsia can also be prevented through the use of medications such as magnesium sulfate. Many complications can be managed with procedures and/or surgery if there is access to a qualified surgeon and appropriate facilities and supplies. For example,
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