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Epidemiology

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Maternal mortality ratio (with Sustainable Development Goal target) as of 2015[1]

Maternal mortality and morbidity are leading contributors to women's health. burden with an It is estimated 303,000 women are killed each year in childbirth and pregnancy worldwide.[2] The global rate in 2017 was 211 maternal deaths per 100,000 live births and 45% of postpartum deaths occurred within 24 hours.[3] Where as in 2020, the global rate was 223 deaths per 100,000 live births[4]. Ninety-nine percent of maternal deaths occur in low-resource countries.[5]

Country Prevalence

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At a country level, India (19% or 56,000) and Nigeria (14% or 40,000) accounted for roughly one third of the maternal deaths in 2010.[6] Democratic Republic of the Congo, Pakistan, Sudan, Indonesia, Ethiopia, United Republic of Tanzania, Bangladesh and Afghanistan accounted for between 3 and 5 percent of maternal deaths each.[7] These ten countries combined accounted for 60% of all the maternal deaths in 2010 according to the United Nations Population Fund report. Countries with the lowest maternal deaths were Greece, Iceland, Poland, and Finland.[8]

In 2017, countries in Southeast Asia and Sub-Saharan Africa accounted for approximately 86% of all maternal deaths worldwide. As of 2020, Sub-Saharan African countries such as South Sudan, Chad, and Nigeria had the highest maternal deaths per 100,000 live births[9]. Sub-Saharan African countries accounted for about two-thirds of the global maternal deaths and Southeast Asian countries accounted for approximately one-fifth. Since 2000, Southeast Asian countries have had a significant decrease in maternal mortality with an overall decrease in maternal mortality of almost 60%.[10] Sub-Saharan Africa also saw an almost 40% decrease in maternal mortality rate between 2000 and 2017. As of 2017, the countries with the highest maternal mortality rates included South Sudan, Somalia, Central African Republic, Yemen, Syria, South Sudan, and the Democratic Republic of the Congo. The numbers for maternal mortality in these countries are likely affect by the political and civil unrest that these countries are facing.[10]

Ethnicity

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Ethnicity plays a big role in access to healthcare. Women who are black and non-hispanic experience pregnancy-related death at a significantly higher rate. They are three to four times as likely to succumb to maternal mortality than non-hispanic white women.[11] Between the years of 2007 and 2014, women who identify as non-hispanic and black had a significant increase in death related to pregnancy.[12] This can be seen throughout different countries. In Brazil, women who are not white were 3.5 times as likely to die because of obstetric mortality compared to white women.[13] The maternal mortality ratio is larger in women who are from Sub-Saharan African in France.[14]

In the United States, according to the Center for Disease Control and Prevention (CDC), the maternal mortality rate in 2021 was 32.9 deaths per 100,000 live births.[15] This is significantly higher than the rates in 2020 defined as 23.8 deaths per 100,000 live births and 20.1 in 2019.[16] In 2021, the maternal mortality rate for non-Hispanic Black women was 69.9 deaths per 100,000 live births, which is 2.6 times higher than non-Hispanic White women.[17] The mortality rate for women over the age of 40 was 6.8 times higher than the rate for women under the age of 25.[18]

COVID-19 Effects

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Global maternal mortality and fetal outcomes have worsened during the COVID-19 pandemic. Increases in maternal deaths, stillbirths, ruptured ectopic pregnancies, and maternal depression occurred globally during this time.[19] According to The Lancet Global Health, their search, which included over 40 studies, identified significant increases in stillbirth and maternal death during the pandemic versus before the pandemic. [20]According to the United Nations Population Fund, UNFPA, a proportion of total COVID-19 deaths were indirect obstetric deaths where a woman's death was due to the aggravation between the disease and the state of pregnancy. Some outcomes show considerable disparity between low- and high-resource settings.[21] This drives the urgent global need to prioritize safe, equitable, and accessible maternal care in future healthcare crises.[22]

Progression of Policy

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Significant progress has been made since the United Nations made the reduction of maternal mortality part of the Millennium Development Goals (MDGs) in 2000.[23]: 1066  Bangladesh, for example, cut the number of deaths per live births by almost two-thirds from 1990 to 2015. A further reduction of maternal mortality is now part of the Agenda 2030 for sustainable development. The United Nations has more recently developed a list of goals termed the Sustainable Development Goals. The target of the third Sustainable Development Goal (SDG) is to reduce the global maternal mortality rate (MMR) to less than 70 per 100,000 live births by 2030.[24] Some of the specific aims of the Sustainable Development Goals are to prevent unintended pregnancies by ensuring more women have access to contraceptives, as well as providing women who become pregnant with a safe environment for delivery with respectful and skilled care. This initiative also included access to emergency services for women who developed complications during delivery.[25]

Prevention Strategies

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The World Health Organization (WHO) has developed a global goal to end preventable death related to maternal mortality.[26] A major goal of this strategy is to identify and address the causes of maternal and reproductive morbidities and mortalities. as well as disabilities related to maternal health outcomes. This strategy aims to address inequalities in access to reproductive, maternal, and newborn services, as well as the quality of care with universal health coverage. Maternal mortality is difficult to measure. Health information systems, such as the CRVS (Civil registration and Vital Statistics), in most low income countries are weak. Therefore these systems cannot provide accurate assessments of maternal mortality. Even estimates derived from complete system such as the CRVs, suffer misclassification, and underreporting statistics of maternal death. The WHO strategy also aims to ensure quality data collection in order to better respond to the needs of women and girls while improving the equity and quality of care provided to women[27].

Variation

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See also

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Article Draft

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Lead

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Article body

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References

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  1. ^ "Maternal mortality ratio". Our World in Data. Retrieved 16 February 2020.
  2. ^ "Trends in maternal mortality: 1990 to 2015". World Health Organization. November 2015. p. 16.
  3. ^ Nour NM (2008). "An introduction to maternal mortality". Reviews in Obstetrics & Gynecology. 1 (2): 77–81. PMC 2505173. PMID 18769668.
  4. ^ "A woman dies every two minutes due to pregnancy or childbirth: UN agencies - PAHO/WHO | Pan American Health Organization". www.paho.org. Retrieved 2023-12-11.
  5. ^ "Maternal mortality: Fact sheet N°348". World Health Organization. WHO. Retrieved 20 June 2014.
  6. ^ "WHO | Facility-based maternal death review in Nigeria". WHO. Archived from the original on May 23, 2017. Retrieved 2020-09-24.
  7. ^ [UNICEF, W. (2012). UNFPA, World Bank (2012) Trends in maternal mortality: 1990 to 2010. WHO, UNICEF.]
  8. ^ "Comparison: Maternal Mortality Rate". The World Factbook. Central Intelligence Agency. Archived from the original on October 30, 2011.
  9. ^ "Maternal mortality: The urgency of a systemic and multisectoral approach in mitigating maternal deaths in Africa" (PDF). Integrated African Health Observatory. The WHO. {{cite journal}}: Check date values in: |date= (help); line feed character in |title= at position 20 (help)
  10. ^ a b "Maternal mortality". www.who.int. Retrieved 2021-04-12.
  11. ^ Howell, Elizabeth A (2018-6). "Reducing Disparities in Severe Maternal Morbidity and Mortality". Clinical obstetrics and gynecology. 61 (2): 387–399. doi:10.1097/GRF.0000000000000349. ISSN 0009-9201. PMC 5915910. PMID 29346121. {{cite journal}}: Check date values in: |date= (help); line feed character in |title= at position 54 (help)
  12. ^ Howell, Elizabeth A (2018-6). "Reducing Disparities in Severe Maternal Morbidity and Mortality". Clinical obstetrics and gynecology. 61 (2): 387–399. doi:10.1097/GRF.0000000000000349. ISSN 0009-9201. PMC 5915910. PMID 29346121. {{cite journal}}: Check date values in: |date= (help); line feed character in |title= at position 54 (help)
  13. ^ Small, M; Allen, T; Brown, HL (2017-8). "Global Disparities in Maternal Morbidity and Mortality". Seminars in perinatology. 41 (5): 318–322. doi:10.1053/j.semperi.2017.04.009. ISSN 0146-0005. PMC 5608036. PMID 28669415. {{cite journal}}: Check date values in: |date= (help)
  14. ^ Small, M; Allen, T; Brown, HL (2017-8). "Global Disparities in Maternal Morbidity and Mortality". Seminars in perinatology. 41 (5): 318–322. doi:10.1053/j.semperi.2017.04.009. ISSN 0146-0005. PMC 5608036. PMID 28669415. {{cite journal}}: Check date values in: |date= (help)
  15. ^ "Maternal Mortality Rates in the United States, 2021". www.cdc.gov. 2023-03-16. Retrieved 2023-11-19.
  16. ^ "Maternal Mortality Rates in the United States, 2021". www.cdc.gov. 2023-03-16. Retrieved 2023-11-19.
  17. ^ "Maternal Mortality Rates in the United States, 2021". www.cdc.gov. 2023-03-16. Retrieved 2023-11-19.
  18. ^ "Maternal Mortality Rates in the United States, 2021". www.cdc.gov. 2023-03-16. Retrieved 2023-11-19.
  19. ^ Chmielewska, Barbara; Barratt, Imogen; Townsend, Rosemary; Kalafat, Erkan; van der Meulen, Jan; Gurol-Urganci, Ipek; O'Brien, Pat; Morris, Edward; Draycott, Tim; Thangaratinam, Shakila; Le Doare, Kirsty; Ladhani, Shamez; von Dadelszen, Peter; Magee, Laura; Khalil, Asma (2021-06). "Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis". The Lancet Global Health. 9 (6): e759–e772. doi:10.1016/s2214-109x(21)00079-6. ISSN 2214-109X. PMC 8012052. PMID 33811827. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  20. ^ Chmielewska, Barbara; Barratt, Imogen; Townsend, Rosemary; Kalafat, Erkan; van der Meulen, Jan; Gurol-Urganci, Ipek; O'Brien, Pat; Morris, Edward; Draycott, Tim; Thangaratinam, Shakila; Le Doare, Kirsty; Ladhani, Shamez; von Dadelszen, Peter; Magee, Laura; Khalil, Asma (2021-06). "Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis". The Lancet Global Health. 9 (6): e759–e772. doi:10.1016/s2214-109x(21)00079-6. ISSN 2214-109X. PMC 8012052. PMID 33811827. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  21. ^ "Trends in Maternal Mortality 2000-2020". United Nations Population Fund. Retrieved 2023-11-19.
  22. ^ Chmielewska, Barbara; Barratt, Imogen; Townsend, Rosemary; Kalafat, Erkan; van der Meulen, Jan; Gurol-Urganci, Ipek; O'Brien, Pat; Morris, Edward; Draycott, Tim; Thangaratinam, Shakila; Le Doare, Kirsty; Ladhani, Shamez; von Dadelszen, Peter; Magee, Laura; Khalil, Asma (2021-06). "Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis". The Lancet Global Health. 9 (6): e759–e772. doi:10.1016/s2214-109x(21)00079-6. ISSN 2214-109X. PMC 8012052. PMID 33811827. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  23. ^ Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF (April 2006). "WHO analysis of causes of maternal death: a systematic review" (PDF). Lancet. 367 (9516): 1066–1074. doi:10.1016/S0140-6736(06)68397-9. PMID 16581405. S2CID 2190885. Archived from the original (PDF) on 2017-10-31. Retrieved 2018-08-05.
  24. ^ "Health - United Nations Sustainable Development". United Nations.
  25. ^ "Maternal health". United Nations Population Fund. Retrieved 2017-01-29.
  26. ^ "Maternal mortality". World Health Organisation.
  27. ^ "Maternal mortality". www.who.int. Retrieved 2023-12-11.
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