Maternal Mortality in Developing Countries

According to the latest estimates of the World Health Organisation (WHO) and the United Nations International Children’s Emergency Fund (UNICEF), 529,000 women still die every year from complications of their pregnancy, and nearly 90% of these deaths are in sub-Saharan Africa and Asia [1]. Obstetric complications continue to represent the major cause among women of childbearing age, far ahead of tuberculosis, suicide, sexually transmitted diseases, or AIDS [2]. While developed countries have made enormous progress in bringing down the huge death rates associated with pregnancy, women in developing countries continue to face very high risks of death and disability as a result of pregnancy. The risk of a woman dying as a result of pregnancy or childbirth during her lifetime is about 1 in 6 in the poorest parts of the world compared with about 1 in 30,000 in Sweden [3]. The growing awareness of the continuing high rates of maternal mortality during the early 1980s led to the launch of the Safe Motherhood Initiative in Nairobi in 1987. After this “call for action,” governmental and nongovernmental organisations joined forces to reduce the huge burden of maternal mortality in the world. Substantial progress has been made in documenting the extent of maternal ill health, and many of the actors involved have now embraced safer motherhood as among the highest priorities in public health practice. As a result, the reduction of maternal mortality is now one of the major targets promoted within the Millennium Development Goals set up by the United Nations in 2000 [4]. The recent World Health Report [2] also marked two decades of attention for Safe Motherhood and highlighted key strategies that may make pregnancy safer. The aim of this chapter is to review the evidence underlying the strategies proposed to reduce the huge burden of maternal mortality. It starts off by documenting the magnitude of maternal mortality while briefl y highlighting the problems associated with its measurement. After a review of the main factors known to contribute to maternal mortality, the strategies that have been proposed to reduce the high levels of maternal mortality in the world are discussed.