Title: Maternal deaths and complications
Course: Antenatal Care Part 1 - Ethiopia (Full)

Maternal deaths and complications

A maternal death (also known as a maternal mortality) is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration (length) and the site of pregnancy, from any cause related to, or aggravated by, the pregnancy or its management, but not from accidental or incidental causes (i.e. causes of death not related to the pregnancy). The five major causes of maternal mortality are:

- unsafe abortion
- eclampsia (caused by dangerously high blood pressure during the pregnancy)
- obstructed labour
- postpartum haemorrhage (bleeding after childbirth)
- puerperal sepsis (bloodstream infection after childbirth).

You will learn about each of these causes in detail in later study sessions in this Module. Here we are focusing on how data on maternal deaths are collected and reported, so you can estimate the maternal mortality in your catchment area.

Every year the WHO estimates that worldwide around 536,000 women die from complications of pregnancy and childbirth, and that 99% of them are in developing countries. At least 7 million women who survive childbirth suffer serious long-term health problems, and a further 50 million women suffer some adverse health consequences after childbirth. The overwhelming majority of these complications occur in developing countries (WHO Report on Progress Towards Achieving the Millennium Development Goals, published 2009).

Each year in Africa, 30 million women become pregnant, and 18 million give birth at home without skilled care from a trained health professional. As a consequence, every year over 250,000 African women die because of complications related to pregnancy and childbirth, and four million African women have non-fatal complications of pregnancy (Save the Children, USAID, UNFPA, UNICEF, WHO, Opportunities for Africa's Newborns: Practical Data, Policy and Programmatic Support for Newborn Care in Africa, 2006).

What proportion of the worldwide number of maternal deaths occurs in Africa?

Show answer

African women account for almost half of the 536,000 women who die every year as a consequence of complications of pregnancy or childbirth.

Maternal mortality ratios (MMRs)

The best way of comparing the extent of maternal deaths in different parts of the world is to calculate the maternal mortality ratio (MMR), which tells you the number of maternal deaths that occur in every 100,000 live births. The MMR is internationally recognised as one of the most important indicators of maternal health and the quality of antenatal, delivery and postnatal care in a country. Later in this study session, we will show you how to calculate the maternal mortality ratio in your catchment area.

The Ethiopian Demographic and Health Surveys (EDHS) of 2000 and 2005 have produced estimates of the maternal mortality ratio for the country as a whole. In 2000, for every 100,000 live births in Ethiopia, 871 mothers died because of complications of pregnancy or childbirth. By 2005, this number had fallen to 673 per 100,000 live births — well below the average of 900 per 100,000 live births for Africa as a whole, but still one of the highest in the world. In 2008, the global average MMR was 400 maternal deaths per 100,000 live births, and the European average was only 27 per 100,000 live births.

Figure 1.1 Proportion of home and institutional births in Ethiopia in 2005.

In Ethiopia in 2005, an estimated 3,119,000 million women gave birth. Figure 1.1 shows that 94% of these births occurred at home — mostly in rural communities like yours (EDHS, 2005).

Calculate the number of maternal mortalities in Ethiopia in 2005, based on the MMR for that year.

Show answer

The MMR in 2005 = 673 per 100,000 live births and there were 3,119,000 total births that year. 3,119,000 divided by 100,000 = 31.19. So, in the country as a whole, 31.19 × 673 = 20,991 women died as a consequence of complications of pregnancy or childbirth.

Although MMRs give public health policy makers a measurement of the magnitude of the problem of maternal deaths, they cannot inform us about what interventions are needed to save women's lives. Studying this Blended Learning Module and the next two, which are on Labour and Delivery Care and Postnatal Care, together with the associated practical training for these Modules, will enable you to reduce maternal mortalities in your community.