Below are the most frequently asked questions about global maternal health that the Maternal Health Task Force receives. Do you have a question that you think should be added to this list? Send us an email with your question.
What is maternal health?
Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period.
A maternal death is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”
How is maternal health measured?
There are numerous indicators used to measure and track maternal health across the globe. One of the most commonly used indicators is the maternal mortality ratio (MMR). A MMR is the number of maternal deaths per 100,000 live births in a given population. Other common indicators include skilled birth attendance, number of antenatal care visits and facility-based deliveries. Access to and utilization of maternal health care services, however, is not necessarily a proxy for high quality of care, which is critical to improving health outcomes. Measuring the quality of maternal health care can be especially challenging.
A variety of strategies are used to access maternal health data at the global (e.g., Global Burden of Disease Study), national (e.g., Demographic and Health Surveys) and local (e.g., health facility audits) levels. Countdown to 2030 reports country-level data on coverage of essential maternal health services. Unfortunately, many countries with weak health information systems do not have the capacity to regularly collect, manage and distribute accurate data on maternal health indicators.
What is the current maternal mortality ratio (MMR)?
Data from the Global Burden of Disease Study 2015 estimate that the global MMR is 196 deaths per 100,000 live births. According to the World Health Organization (WHO), which uses a different methodology to calculate this figure, the global MMR is even higher, at approximately 216 deaths per 100,000 live births. National MMRs vary widely, as illustrated in the table below.
Are maternal deaths decreasing over time?
The global MMR has decreased from 385 maternal deaths per 100,000 live births in 1990 to 216 maternal deaths per 100,000 live births in 2015. However, some regions have made more progress than others: During this period, the annual rate of MMR reduction ranged from 1.8% in the Caribbean to 5% in eastern Asia.
What are the causes of maternal deaths?
The causes of maternal mortality around the globe have been well studied, and the majority of maternal deaths are preventable. While the exact percentages vary depending on data source, methodology and categorization, most studies have identified postpartum hemorrhage, maternal hypertension or pre-eclampsia/eclampsia, sepsis and unsafe abortion as the most common direct causes of maternal death around the globe. The distribution of causes of maternal mortality varies by region.
Indirect causes account for more than a quarter of global maternal deaths and include pre-existing conditions such as HIV, obesity, anemia, diabetes and cancer. Despite the high prevalence of maternal deaths linked to indirect causes, the literature in this area is limited.
There are also a number of social determinants that affect maternal health such as place of residence, socioeconomic status and race/ethnicity influence a woman’s risk of dying during pregnancy, childbirth or the immediate postpartum period.
What services are generally included in maternal health care?
Maternal health care generally consists of antenatal care (during pregnancy), intrapartum care (during labor and delivery) and postpartum care (following delivery). Other services, such as family planning counselling or HIV treatment are often integrated into antenatal or postnatal care visits.
Antenatal care includes a number of services such as educating women about healthy pregnancy behaviors, danger signs of complications, breastfeeding and family planning; screening for, identifying and treating pregnancy-related conditions such as pre-eclampsia/eclampsia; refer mothers to specialized care when necessary; and counselling women about their delivery options and encouraging the use of a skilled birth attendant. The current recommendation from WHO is that women receive at least eight antenatal contacts.
Intrapartum care includes basic services such as monitoring cervical dilation, checking the woman’s and fetus’s heart rates and ensuring normal levels of blood loss, as well as emergency obstetric and newborn care (EmONC) in cases of childbirth-related complications. Some common EmONC services include cesarean section surgery, management of postpartum hemorrhage or pre-eclampsia/eclampsia and neonatal resuscitation.
Postnatal care includes counselling women about healthy breastfeeding practices and family planning options; screening for postpartum depression and other mental health issues; monitoring the newborn’s growth and overall health status; treating childbirth-related complications; and referring the mother and baby for specialized care if necessary, among other services. WHO recommends that all women and newborns receive at least three postnatal contacts following delivery—the first between 48 and 72 hours, the second between days 7 and 14 and the third at six weeks postpartum.
Where and with whom do women deliver?
Women give birth in various places: in hospitals, at home, in community health centers, or at freestanding midwifery units. The distribution of delivery locations varies widely across geography and based on factors including socioeconomic status, place of residence and previous experiences with the health care system.
In health facilities, women generally deliver with midwives, obstetricians and nurses. Home births are often attended by a traditional birth attendant or midwife. Notably, in some areas, women deliver with no one present.
The most widely accepted definition of a “skilled birth attendant” is “an accredited health professional—such as a midwife, doctor or nurse—who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.” However, some have argued that this indicator is limited in its ability to measure quality of care. Similarly, facility-based delivery is not always an accurate indicator of quality since many health facilities, particularly in low-income countries, are not able to provide high quality intrapartum care.
How many women use family planning?
Graph: United Nations. Trends in contraceptive use worldwide, 2015.
As of 2015, approximately 64% of married or in-union women of reproductive age worldwide use some form of contraception. However, usage varies regionally, from 33% in Africa to 75% in North America. Roughly 12% of married or in-union women globally have an unmet need for family planning. Unmet need also varies widely by region, ranging from 5% in Eastern Asia to 26% in Central Africa.
Barriers to contraceptive use include fear of side effects, lack of access to family planning services, sociocultural beliefs and a limited knowledge about contraceptives.
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