Postpartum Hemorrhage in Asian Countries: Available Data and Interpretation

Asia is one of the world’s largest continents, stretching from the Arctic Ocean to the Equator and from Sumatra and Borneo in the south-east to the Suez Canal in the south-west. Its northwestern boundary comprises the Ural Mountains and the Ural River. As such, Asia is home to approximately two-thirds of the world’s population, contains its two largest nations (China and India), is home to three of the longest rivers in the world (Ob, Yangtze and Amur) and comprises deserts as well as paddy fields and coconut plantations. Within Asia, postpartum hemorrhage is a significant cause of maternal mortality and morbidity, although sharp differences exist across Asian countries in the maternal mortality ratio, which is itself a measure of socioeconomic well-being1. The major causes of maternal mortality and the manner in which the maternal mortality ratio has fallen also vary between Asian countries. Obstetric hemorrhage is often the most common cause of maternal deaths within Asia. The recognition of this fact and improvements in care, targeted at the management of women with hemorrhage, are both important challenges facing governments as well as medical authorities. A striking feature about Asia in recent decades is the increase in the gross domestic product of most nations, and the fact that this advance was not always accompanied by a decrease in maternal deaths from hemorrhage. Even in Japan, which has a modern and mature economy, obstetric hemorrhage is the most common cause of maternal mortality, and inadequate obstetric services have been blamed for maternal deaths2. In stark contrast, the gross domestic product of Hong Kong increased 14-fold between 1966 and 19853, while the maternal mortality ratio dropped nine-fold between 1961 and 19854. In September 2000, representatives from 189 nations met at the United Nations Millennium Summit in New York and endorsed the Millennium Declaration with its eight goals. The Millennium Declaration represents a global agenda for the start of the twenty-first century to promote human development and to reduce global inequalities. Goal number 5 was to improve maternal health. Some Asian countries, such as Thailand and China, have already published progress reports on their achievement of the Millennium Development goals5,6. Since that time, there have been encouraging signs in the management of postpartum hemorrhage in Asia. Two issues are very clear. First, Asian countries are making strident efforts to control maternal mortality due to postpartum hemorrhage. Second, it is clear that both the Asian gross domestic product and population numbers will continue to rise. How these obviously intertwined phenomena will affect maternal deaths from hemorrhage will depend on factors other than the gross domestic product alone.