THE QUEST FOR TRUTH: COME NOW AND LET US REASON TOGETHER

     

Key facts

Every day in 2017, approximately 810 women died from preventable causes related to pregnancy và childbirth.Between 2000 and 2017, the maternal mortality ratio (MMR, number of maternal deaths per 100,000 live births) dropped by about 38% worldwide.94% of all maternal deaths occur in low và lower middle-income countries.Young adolescents (ages 10-14) face a higher risk of complications & death as a result of pregnancy than other women.Skilled care before, during & after childbirth can save the lives of women and newborns.

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Maternal mortality is unacceptably high. About 295000 women died during and following pregnancy and childbirth in 2017. The vast majority of these deaths (94%) occurred in low-resource settings, & most could have been prevented. (1)

Sub-Saharan Africa and Southern Asia accounted for approximately 86% (254000) of the estimated global maternal deaths in 2017. Sub-Saharan Africa alone accounted for roughly two-thirds (196000) of maternal deaths, while Southern Asia accountedfor nearly one-fifth (58000).

At the same time, between 2000 và 2017, Southern Asia achieved the greatest overall reduction in MMR: a decline of nearly 60% (from an MMR of 384 down lớn 157). Despite its very high MMR in 2017, sub-Saharan Africa as a sub-region also achieved a substantialreduction in MMR of nearly 40% since 2000. Additionally, four other sub-regions roughly halved their MMRs during this period: Central Asia, Eastern Asia, Europe và Northern Africa. Overall, the maternal mortality ratio (MMR) in less-developed countriesdeclined by just under 50%.

Where do maternal deaths occur?

The high number of maternal deaths in some areas of the world reflects inequalities in access to chất lượng health services và highlights the gap between rich & poor. The MMR in low income countries in 2017 is 462 per 100000 live births versus 11per 100000 live births in high income countries.

In 2017, according lớn the Fragile States Index, 15 countries were considered khổng lồ be “very high alert” or “high alert” being a fragile state (South Sudan, Somalia, Central African Republic, Yemen, Syria, Sudan, the Democratic Republicof the Congo, Chad, Afghanistan, Iraq, Haiti, Guinea, Zimbabwe, Nigeria and Ethiopia), & these 15 countries had MMRs in 2017 ranging from 31 (Syria) to lớn 1150 (South Sudan).

The risk of maternal mortality is highest for adolescent girls under 15 years old & complications in pregnancy and childbirth are higher among adolescent girls age 10-19 (compared to women aged 20-24) (2,3).

Women in less developed countries have, on average, many more pregnancies than women in developed countries, and their lifetime risk of death due to lớn pregnancy is higher. A woman’s lifetime risk of maternal death is the probability that a 15 yearold woman will eventually die from a maternal cause. In high income countries, this is 1 in 5400, versus 1 in 45 in low income countries.

Why vì women die?


Women die as a result of complications during và following pregnancy and childbirth. Most of these complications develop during pregnancy và most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy,especially if not managed as part of the woman’s care. The major complications that tài khoản for nearly 75% of all maternal deaths are (4):

severe bleeding (mostly bleeding after childbirth)infections (usually after childbirth)high blood pressure during pregnancy (pre-eclampsia and eclampsia) complications from deliveryunsafe abortion.

The remainder are caused by or associated with infections such as malaria or related lớn chronic conditions lượt thích cardiac diseases or diabetes.

<1>Fragile States Index is an assessment of 178 countries based on 12 cohesion, economic, social và political indicators, resultingin a score that indicates their susceptibility khổng lồ instability. Further information about indicators and methodology is available at: https://fragilestatesindex.org/


How can women’s lives be saved?

Most maternal deaths are preventable, as the health-care solutions lớn prevent or manage complications are well known. All women need access khổng lồ high chất lượng care in pregnancy, & during và after childbirth. Maternal health & newborn health are closelylinked. It is particularly important that all births are attended by skilled health professionals, as timely management và treatment can make the difference between life & death for the mother as well as for the baby.

Severe bleeding after birth can kill a healthy woman within hours if she is unattended. Injecting oxytocics immediately after childbirth effectively reduces the risk of bleeding.

Infection after childbirth can be eliminated if good hygiene is practiced và if early signs of infection are recognized and treated in a timely manner.

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Pre-eclampsia should be detected & appropriately managed before the onset of convulsions (eclampsia) và other life-threatening complications. Administering drugs such as magnesium sulfate for pre-eclampsia can lower a woman’s riskof developing eclampsia.

To avoid maternal deaths, it is also vital lớn prevent unwanted pregnancies. All women, including adolescents, need access lớn contraception, safe abortion services lớn the full extent of the law, and chất lượng post-abortion care.

Why vị women not get the care they need?

Poor women in remote areas are the least likely khổng lồ receive adequate health care. This is especially true for regions with low numbers of skilled health workers, such as sub-Saharan Africa và South Asia.

The latest available data suggest that in most high income & upper middle income countries, more than 90% of all births benefit from the presence of a trained midwife, doctor or nurse. However, fewer than half of all births in several low incomeand lower-middle-income countries are assisted by such skilled health personnel (5)

The main factors that prevent women from receiving or seeking care during pregnancy & childbirth are:


povertydistance lớn facilitieslack of informationinadequate & poor chất lượng servicesculturalbeliefs and practices.

To improve maternal health, barriers that limit access to chất lượng maternal health services must be identified and addressed at both health system và societal levels.

The Sustainable Development Goals và Maternal Mortality

In the context of the Sustainable Development Goals (SDG), countries have united behind a new target to accelerate the decline of maternal mortality by 2030. SDG 3 includes an ambitious target: “reducing the global MMR khổng lồ less than 70 per 100000births, with no country having a maternal mortality rate of more than twice the global average”.

nangngucnoisoi.vn response

Improving maternal health is one of nangngucnoisoi.vn’s key priorities. nangngucnoisoi.vn works to contribute lớn the reduction of maternal mortality by increasing research evidence, providing evidence-based clinical & programmatic guidance, setting global standards,and providing technical support to thành viên States on developing & implementing effective policy and programmes.

As defined in the Ending Preventable Maternal Mortality Strategy (6), nangngucnoisoi.vn is working with partners in supporting countries towards:

addressing inequalities in access to and quality of reproductive, maternal, and newborn health care services; ensuring universal health coverage for comprehensive reproductive, maternal, & newborn health care;addressing all causes of maternal mortality, reproductive và maternal morbidities, & related disabilities;strengthening health systems to lớn collect high chất lượng data in order to lớn respond lớn the needs và priorities of women and girls; andensuring accountability in order khổng lồ improve quality of care and equity.

(1)Trends in maternal mortality: 2000 khổng lồ 2017: estimates by nangngucnoisoi.vn, UNICEF, UNFPA, World bank Group & the United Nations Population Division. Geneva: World Health Organization; 2019.

(2)Ganchimeg T, Ota E, Morisaki N, et al. Pregnancy và childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014;121 Suppl 1:40–8.

(3)Althabe F, Moore JL, Gibbons L, et al. Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network’s Maternal Newborn Health Registry study. Reprod Health 2015;12 Suppl 2:S8.

(4) Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels JD, et al.Global Causes of Maternal Death: A nangngucnoisoi.vn Systematic Analysis. Lancet Global Health. 2014;2(6): e323-e333.

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(5)World Health Organization & United Nations Children’s Fund. nangngucnoisoi.vn/UNICEF joint database on SDG 3.1.2 Skilled Attendance at Birth. Available at: https://unstats.un.org/sdgs/indicators/database/

(6) Strategies towards ending preventable maternal mortality (‎EPMM)‎.Geneva:World Health Organization; 2015.