How to Prevent Maternal Mortality Injustices Around the World
According to the World Health Organization (WHO), 295,000 women died from preventable causes related to pregnancy and childbirth in 2017. Unfortunately, the overwhelming majority of maternal deaths (94%) occur in developing countries. Many nonprofit, government, and health care organizations around the world have made maternal mortality a top priority in their efforts to improve global and national health and well-being.
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Maternal Mortality Rate (MMR) Across the Globe
Between 2000 and 2017, the global MMR decreased by 38%. But many developing countries still have extremely high MMRs, and some countries with advanced economies (like the U.S.) have seen their MMRs increase over the past few decades.
Statistics of Global MMRs
In 2017, 295,000 women died during and following pregnancy and childbirth. Studies indicate that adolescent girls under 15 have the highest risk of maternal mortality, and adolescent girls ages 10-19 have the highest risks of complications in pregnancy and childbirth.
In nearly 75% of all maternal deaths, the major maternal complications include severe bleeding, infections, high blood pressure, complications from delivery, and unsafe abortions. According to WHO, maternal complications may also be “caused by or associated with infections such as malaria or related to chronic conditions like cardiac diseases or diabetes.”
Statistics of MMRs in the U.S.
In the U.S., MMRs can be four times higher for women who don’t receive prenatal care, compared with women who do. Additionally, for the past six decades, pregnancy-related deaths among American Indian/Alaska Native and non-Hispanic black women have been nearly four times more common than among white women.
Studies also indicate that 25% of American women don’t receive the recommended number of prenatal visits. This stat jumps to 32% among African American women, and 41% among American Indian or Alaska Native women. What’s more, 21% of pregnant women in the U.S. experience moderate to severe depression or anxiety, negatively impacting the mother, child, and family.
MMRs are particularly an issue in developing countries. For instance, for every 100,000 live births in 2015, there were 1,360 deaths Sierra Leone, 882 Central African Republic, and 856 in Chad.
Risks and Barriers to Health Care
During pregnancy and postpartum, women are at risk for certain medial conditions that may impact not only their health, but also the health of their child.
Causes of Maternal Mortality in the U.S.
The primary causes of pregnancy-related deaths vary depending on the stage of the pregnancy/postpartum cycle. For instance, cardiovascular conditions are a leading cause during pregnancy, on delivery day, and 43 to 365 days post-partum. Infections, on the other hand, are a leading cause during pregnancy, the first week postpartum, and 7 to 42 days postpartum.
Postpartum and Perinatal Depression in the U.S.
1 in 9 expectant mothers will experience symptoms of postpartum depression. These symptoms include excessive crying, panic attacks, social withdrawal, and difficulty bonding with the baby. The risks associated with the condition include suicidal thoughts, preterm births, and low birth weight.
Simple Solutions for Common Complications
There are various medical solutions that can help stave off common complications associated with birth. For example, injecting oxytocics immediately after childbirth reduces bleeding risks, and practicing good hygiene can help lower the risk of infection. Yet even though simple solutions exist for pregnancy and childbirth complications, health care professions in many developing countries unfortunately lack the resources and expertise to implement them. Most births across several low-income and lower-middle-income countries are not assisted by skilled health personnel.
There are several barriers to quality maternal health care. These include poverty, distance to facilities, and poor service quality. In the U.S., closure of rural hospitals and obstetrics programs is leading to obstetrical deserts and poor health outcomes, which points to the need for highly qualified women’s health nurse practitioners in these areas.
Strategies to Reduce and Prevent Maternal Mortality
The WHO, the U.S. Department of Health and Human Services (HHS), and the American academy of Family Physicians (AAFP) have announced detailed strategies for reducing maternal mortality rates.
For instance, the WHO’s “Ending Preventable Maternal Mortality Strategy” involves working with partners in supporting countries toward addressing inequalities to quality care services, ensuring universal reproductive, maternal, and newborn health care, and ensuring accountability that improves quality of care and equity. The AAFP has also outlined several objectives to decrease MMRs, including the evaluation of evidence-based methods to decrease maternal mortality and addressing the growing loss of rural maternity services nationwide.
Additionally, HHS’s HRSA Maternal Mortality Summit – Technical Report summarizes key findings on actions to decrease rates of maternal mortality and morbidity. These include improving access to patient-centered, comprehensive care for women in the pregnancy cycle, providing continuity of care before, during, and after pregnancies, and improving the quality and availability of national surveillance and survey data, research, and common terminology and definitions.
As public health officials continue to collaborate with health care organizations, women’s health nurses practitioners and other health care professionals will play a key role in implementing solutions for reducing MMRs in the U.S. and abroad.