Each year, 525 000 women die from maternal causes. For each woman who dies in the north, 99 will die in the south. This report looks behind these indicators of the widening gap between rich and poor – within and between countries. Although the evidence is stark, it argues that international improvement targets can be met.

Women in sub-Saharan Africa face the greatest risk of maternal death. The tragedy is that almost every one of these deaths is avoidable. According to this research, they are caused by social injustices, poverty, undesired fertility and by lack of access to safe, legal abortion and adequate maternity services. Furthermore, when a woman dies in this way, the problem rebounds on the whole community: on older siblings, families, neighbours and friends.

The study identifies three major areas where lack of prompt action effectively bars a woman’s access to care. These include delay in (1) recognising that there is a problem and making the decision to seek care, (2) reaching care, often due to poor transport, and (3) receiving adequate treatment at the health facility.

The study presents the following key findings:

• Across regions, the lifetime risk of maternal death varies from 1 in 4,000 in Northern Europe to 1 in 16 in sub-Saharan Africa and 1 in 12 in east and west Africa.
• In South-East Asia, the lifetime risk of maternal death is 1 in 55, in the Caribbean 1 in 75, and in South America 1 in 140.
• Maternal health complications contribute to the deaths of at least 1.5 million infants in the first week of life and 1.4 million stillborn babies.
• Each year, over 15 million women experience severe pregnancy-related complications, which lead to long-term illness or disability.
• Over the last decade, research has shown that many widely-adopted practices in maternity care are not beneficial for women and may even be harmful.

In 1987, the International Safe Motherhood Initiative was launched in Nairobi. It aimed to halve maternal deaths by the year 2000. Some countries have met with relative success but there is no evidence of significant reductions globally. However, this report argues that the latest target – a seventy-five per cent reduction of the 1990 death rate by 2015 – is achievable. In order to succeed:

• Governments would need to implement changes in the laws and policies that limit women’s choices about when and how often they bear children.
• The health sector must improve maternity services to give every woman access to (1) the assistance of a skilled midwife at birth and (2) comprehensive, emergency obstetric services when required.
• Care must be based on scientific evidence and must foster women’s well-being.
• Health services should be made more accountable.
• Women, their families and communities should be provided with the information they need to prepare for pregnancy and birth.

Source(s):
‘Birth rights. New approaches to safe motherhood’, The Panos Institute, 2001 Full document.

Funded by: DFID, SIDA, NORAD

id21 Research Highlight: 5 September 2002

Further Information:
Kelly Hawrylyshyn
The Panos Institute
9 White Lion St
London N1 9PD
UK

Tel: +44 (0)20 7278 1111
Fax: +44 (0)20 7278 0345
Contact the contributor: kellyh@panoslondon.org.uk

Panos Institute, UK

Other related links:
'Dicing with death? The impact of hospital choice and other factors on maternal mortality'

'Every death counts: using a census to measure maternal mortality'

'The price of women’s health: safe motherhood in low-income countries'

See id21's collection of links relevant to maternal and child health