Maternal Mortality: A Priority Issue In Reproductive Health

Abstract

Maternal mortality is best defined as death of women during pregnancy or within 42 days of termination of pregnancy from a cause related to or aggravated by pregnancy or its management but not from accidental or incidental cause. Pregnancy is not a disease and pregnancy related morbidity and mortality are preventable. Despite that, more than half a million maternal deaths are reported worldwide each year, with vast majority of these deaths occurring in developing countries. 1 In Western hemisphere of world, maternal mortality ratio (MMR) remained disturbingly high form late nineteenth century till the mid 1930’s and then began to fall rapidly. A comparison of MMRs between 1870 and 1950 in certain European countries, especially Great Britain, Australia, New Zealand and the USA, suggests that between 1870 and 1935, it was usually considered safe to be delivered at home by a welltrained midwife rather than by a doctor in a hospital but it was no safer to be rich rather than poor. 2 Canadian regional MMRs were also persistently high until 1939, then showed a declining trend. 3 Advances in obstetrics have contributed in declining these trends but compositional influences were also important. Favourable changes in mother’s age-parity distributions contributed upto 24% drop in MMRs between 19391960 and 1965-1969. Due to their continued efforts, now MMR from developed world is reported from zero to a maximum of 13/100,000 live births (LB). 4 In developed countries, MMR is now a forgotten chapter in the medical history mainly due to their high socioeconomic conditions, better education and advanced obstetric care. While in developing countries, situation in this regard is vice versa. Research reports reveal that majority of maternal deaths are preventable and maternal health depends strongly upon quality of health care, and maternal mortality acts as a litmus test of women, of their access to health care and response of health care to their needs. South Asian developing countries Pakistan, India and Bangladesh have major share in maternal deaths worldwide. These countries account for about 28% of total births and 46% of maternal deaths in the world. Latest available data from India and Bangladesh show that MMRs in these countries have significantly declined during last few years. 5-7 In rural India, MMR upto 260/100,000 LB has been reported. 6