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Understanding the term -

What is meant by maternal mortality? The term refers to three primary measurements that capture deaths arising from maternal conditions.

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Pregnancy-associated death -

First, there is pregnancy-associated death. This refers to experiencing death while pregnant or up to one year post-pregnancy. The cause of death is irrespective of this measurement.

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Pregnancy-related death -

Second, there is pregnancy-related death. This includes the period of gestation and up to one year post-pregnancy. It specifically derives from a pregnancy complication. This is the measurement primarily used by the United States Centers for Disease Control (CDC).

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Maternal mortality -

Lastly, there is maternal mortality. This term specifically refers to death during pregnancy or death within up to 42 days post-pregnancy (from any cause related to pregnancy and its management). This is the measurement primarily used by the World Health Organization (WHO).

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Central and South Asia -

Between 2000 and 2020, mortality diminished by nearly half. Nearly three-fourths of that dip came from Central and South Asia, where maternity mortality reduced by two-thirds. An additional 12% of the reduction in numbers is from East Asia.

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Sub-Saharan Africa -

In contrast, Sub-Saharan Africa has not managed to achieve such successful numbers, although it has reduced rates by approximately one-third.

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Fall of only 6% -

In comparison, the reduction in the maternity mortality rate in Sub-Saharan Africa only dropped by six percent between 2000 and 2020—a shockingly low percentage of progress.

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Majority of maternal mortality cases -

In fact, according to the 2020 statistics, the majority of women who suffered from maternal mortality were in Africa, accounting for approximately 70% of the world’s total.

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West Africa -

To put a more specific region into context, in West Africa, the maternal mortality rate is nearly 200% higher than in most developed nations.

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Factors that impact mortality -

Mass underdevelopment, extreme rates of poverty, and political insecurity, among other factors, are some of the major obstacles to improving maternal mortality rates across the globe.

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Comparison between Ghana and Nigeria -

Historian and economist Adam Tooze compares Nigeria (pictured is a midwife in Ngala) and Ghana for insights into how different factors improve numbers in one country while decreasing them in the other.

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Nigeria's maternal mortality -

Shockingly, Nigeria accounts for 28% of all maternal mortality. While Nigeria is a country that hosts a great deal of wealth, it also suffers from staggering poverty and political insecurity.

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Morality rate experienced minimal improvement -

Between 2000 and 2020, Nigeria’s mortality rate did see some improvement, but by a very minimal margin of just under 13%.

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Ghana -

Looking at the same region, when we compare Nigeria to Ghana, we see a very different reality. In the same 20-year time span, Ghana experienced an improvement in maternal mortality rates by nearly 50%.

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Still high in comparison -

There is no doubt that the state of maternal mortality in both countries is troubling and, indeed, quite high in comparison to other regions.

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Political stability a major factor -

The progress of Ghana, a relatively stable democratic nation with high levels of civic participation, versus Nigeria, which is actively dealing with several forms of political conflict and corruption, tells us how important some factors are in keeping pregnant women alive.

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Sierra Leone -

Similarly, we can look at another West African nation like Sierra Leone. Since the end of its civil war in 2002, maternal mortality rates dropped immensely, diminishing by nearly 75%.

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East Africa -

In East Africa, countries like Rwanda, Tanzania, Mozambique, and Angola have made extraordinary progress in reducing maternal mortality rates. Some were able to see rates fall by 69%, others up to 76%; a significant feat.

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United States -

But shocking numbers of maternal mortality are not just in developing countries. In fact, you may be surprised to read that the United States has the highest maternal mortality rate among developed countries.

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Shortage of maternity care -

In the United States, relative to births, there is an overall shortage of those providing maternity care. This includes a shortage of obstetrician-gynecologists and midwives.

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Postpartum -

The majority of maternal deaths occur postpartum. There are several factors at play. The United States is the only nation that does not provide postpartum home visits or paid parental leave.

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Preventable complications -

The majority of maternal mortality incidents are deemed as preventable complications that occur during pregnancy and childbirth. The rates have only continued to increase since 2000.

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First six weeks -

The majority of maternal mortality cases in the US (approximately 52%) occur postpartum, often within the first six weeks postpartum, while 17% of cases occur during childbirth.

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Contributors -

What happens postpartum that contributes to such a high percentage of maternal deaths? Typically, the most significant contributors are related to high blood pressure, infection, and severe bleeding.

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Late maternal deaths -

About 12% of maternal deaths occur in the year following the birth. These deaths are typically referred to as late maternal deaths and are often tied to conditions like cardiomyopathy, a form of heart disease.

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Comparison to other nations -

The Commonwealth Fund conducted a study that compared the United States' maternal mortality rate with 10 other high-income countries.

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US versus New Zealand and Norway -

In countries like New Zealand and Norway, for example, the maternal mortality rate was often fewer than three per 100,000 births. In comparison, the ratio in the United States is about 17 per 100,000 births.

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More late maternal deaths -

In comparison to other high-income countries, studies show that women in the US experience more late maternal deaths (deaths up to one year postpartum) than in their developed counterparts.

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Worrying trends -

While the world’s mothers have experienced some progress in terms of maternal mortality, there continue to be worrying trends. Studies show that an increase in maternity care providers is key to mitigating risks to women’s health.

Sources: (Adam Tooze) (Common Wealth Fund)

See also: The science behind phantom pregnancies

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