Maternal health

Nov 2011

Key facts

  • Maternal mortality ratio is unacceptably high in low and some middle income countries. About 99% of all maternal deaths occur in developing countries.
  • It is estimated that 358,000 women died during and following pregnancy and childbirth in 2008 worldwide, which is equivalent to approximately 1000 women dying related to pregnancy and childbirth every day. Of these deaths, 13,000 are estimated to occur in the Western Pacific Region in 2008. Many of these deaths could have been prevented.
  • Skilled care before, during and after childbirth can save the lives of women and newborn babies.

Towards the fifth Millennium Development Goal

  • Improving maternal health is one of the eight Millennium Development Goals (MDGs) adopted by the international community in 2000.
  • Under MDG5, countries committed to reducing maternal mortality by three quarters and achieving universal access to reproductive health between 1990 and 2015.
  • Since 1990, maternal mortality ratio worldwide has dropped by 34%, which means that between 1990 and 2008, the global maternal mortality ratio declined by only 2.3% per year. This is far from the annual decline of 5.5% required to achieve MDG5. In the Western Pacific Region, it have dropped by 59% (130 to 51 per 100 000 live births in 1990 and in 2008 respectively) or 5% per year.
  • While the coverage of maternal health care has been improved in many parts of the world during the past decade, in average only 40% of women in low-income countries benefit from skilled care during childbirth. This means that millions of births are not assisted by a midwife, a doctor or a trained nurse.

Where maternal deaths occur

  • The high number of maternal deaths in some areas of the world reflects inequities in access to health services and highlights the gap between rich and poor.
  • Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and one third occur in South Asia.
  • The maternal mortality ratio in developing countries is 290 per 100 000 live births, while it is 14 per 100 000 live births in developed countries.
  • There are large disparities between countries, with some having extremely high maternal mortality ratios of 1000 or more per 100 000 live births.
  • There are also large disparities within countries, between people with high and low income and between people living in rural and urban areas.
  • Women in developing countries have on average many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is therefore higher.
  • A woman’s lifetime risk of maternal death – the probability that a 15 to 49-year-old woman will eventually die from a maternal cause – is 1 in 4300 in developed countries, while it is 1 in 120 in developing countries. In the Western Pacific Region, it is 1 in 1100 women aged 15-49 years.

The causes of death?

  • Women die as a result of complications during and following pregnancy and childbirth.
  • Most of these complications develop around childbirth or during pregnancy. There are contributing factors, such as anaemia and malnutrition, may exist before pregnancy that may worsened during pregnancy.
  • The major complications that account for 80% of all maternal deaths are:
    • severe bleeding (mostly bleeding after childbirth or postpartum haemorrhage)
    • infections (usually after childbirth)
    • high blood pressure during pregnancy (pre-eclampsia and eclampsia)
    • obstructed labour
    • unsafe abortion
  • There are other indirect causes of maternal deaths, such as malaria and other infections, cardiovascular diseases and diseases that are aggravated by pregnancy.
  • Maternal health and newborn health are closely linked. More than three million newborn babies die every year, and an additional three million babies are stillborn.

Why women don't get the care they need

  • Poor women in remote areas are the least likely to receive adequate health care.
  • This is especially true for regions with low numbers of skilled health workers.
  • Other factors that prevent women from receiving or seeking care during pregnancy and childbirth are:
    • poverty
    • distance from medical services
    • lack of information
    • inadequate and lack of women-centered services
    • cultural factors

WHO's response

  • Improving maternal health is one of WHO’s key priorities.
  • WHO provides support to countries in their efforts to reduce maternal mortality by providing evidence-based clinical and programmatic guidance and setting global standards.
  • WHO also supports countries to implement policies and programmes and monitor progress.
  • During the United Nations MDG summit in September 2010, UN Secretary-General Ban Ki-moon launched the Global Strategy for Women's and Children's Health, aimed at saving the lives of more than 16 million women and children by 2015 with a special emphasis on accountability on information, results and resources.