Maternal mortality and Morbidity: Key
challenges and solutions in
sub-Saharan Africa
Pregnancy is often a challenging time for women. In most cases there is some kind of sacrifice or trade-off for this responsibility of bringing life into the world. No woman anticipates that part of the sacrifices to be made would include her life, yet, maternal mortality exists. In regions such as sub-Saharan Africa, the maternal mortality ratio doubles the global average, such that making it through pregnancy and childbirth alive can feel like a privilege.
Maternal mortality is defined as the death of a woman while she is pregnant or within 42 days of termination of pregnancy, irrespective of the site or duration of pregnancy, from factors related to or aggravated by the pregnancy but not from accidental or incidental causes.
Major causes of maternal mortality
The major obstetric causes of maternal deaths have been identified as
Haemorrhage (bleeding)
Hypertensive conditions
Unsafe abortions
Infections,
Obstetric complications such as obstructed labour.
Can maternal mortality be prevented?
The good news is that most maternal deaths are preventable. The bad news is that this means many lives lost to pregnancy-related deaths could have been prevented . Reducing maternal mortality demands a proactive approach including improving access to maternal and antenatal care . These, alongside prompt and appropriate treatment of postpartum complications, culminate in safe childbirth and reduction in pregnancy-related deaths.
Suggested maternal mortality solutions have included:
Delivery by skilled birth attendants: The ability of birth attendants to anticipate, identify and address complications is crucial to the birthing process.
Skilled antenatal care: Effective antenatal care includes several interventions such as screening for and management of anaemia, HIV and other sexually transmitted infections, hypertensive disorders etc that would otherwise alter the course of pregnancy and result in death of the mother. Accessing, attending and heeding to antenatal advice contributes immensely to maternal health globally.
Adequate obstetric care: Appropriate infrastructure and skilled attendants makes for skilled attendance to pregnant women.
Contraception and family planning: Preventing pregnancy in women who do not desire pregnancy trickles down to prevent pregnancy-related deaths.
Despite the identification of effective interventions for reducing maternal mortality, developing countries still struggle to keep their maternal mortality ratios (MMR) down. For this reason, reduction in maternal mortality is one of the sustainable development goals (SDG) of the World Health organisation. The global maternal mortality ratio has steadily decreased over the years from 441 [403 - 490] in 1985 to 223 [202 - 255] in 2020, but certain countries including South Sudan (1220), Chad (1060), Nigeria (1,050), Afghanistan (620) still have their ratios significantly exceeding the global average.
So, the SDG 3.1 target is for individual countries to reduce their MMRs by two-thirds from their 2010 baseline while countries with MMR above 420 reduce their MMRs to no greater than 140 maternal deaths per 100 000 live births. Middle- and low-income countries face challenges of problem identification and solution implementation making this difficult.
How data collection can help reduce maternal mortality
Modern healthcare services rely on an iterative process of data collection, reassessment of current methods and implementation of informed improvements. However, the paucity of available data in these regions impedes this process.
Some types of data that may be useful to collect include:
Maternal demographic & geographic data: This helps identify at-risk groups and tailor interventions accordingly.
Health system data: This identifies gaps in the healthcare infrastructure.
Maternal health status: Knowledge of pre-existing conditions and pregnancy-related complications aid the provision of targeted care.
Cause of death: This helps to distinguish between maternal mortalities and death of pregnant women from incidental or accidental causes as well as identifying specific causes of maternal mortality.
Delay data: is extremely essential in LMICs as poor health seeking behaviour, poor infrastructure and other causes of delay are possible contributing factors to maternal mortality.
The collection and publication of this data can drive research and ideation geared towards reducing maternal mortality.
With data to identify problems, the next challenge lies with implementation. Often impeded by low funding and bureaucratic sloth, good ideas can remain in the pipelines for extended periods. Speeding up the execution process and getting quick feedback will allow timely and effective interventions to emerge.
Maternal mortality ratios are a significant marker of a society’s well-being. Although ill women can get pregnant women, pregnant women are not in themselves ill, and so, we do not expect death and must do all that is in our power to prevent it. Pregnancy, motherhood, and child-bearing, for all who undertake it, should not be an existential threat.
By
Naomi A. Frank-Opigo
References:
Rimmer, M.P., & Al Wattar, B. H. (2021). Research in obstetrics and gynaecology: Challenges, opportunities, and future perspectives. Obstetrics and Gynecology Research, 4(3), 154–157. https://doi.org/10.1016/j.ogre.2021.09.005
Frank, H. G., Raabe, A. L., Gille, C., & Kaufmann, P. (2019). Maternal mortality: Current aspects of clinical management. Donald School Journal of Ultrasound in Obstetrics and Gynecology, 13(4), 324-332. https://www.dsjuog.com/abstractArticleContentBrowse/DSJUOG/18925/JPJ/fullText
World Health Organization. (n.d.). Maternal mortality ratio (MMR) by country. WHO Global Health Observatory. https://data.who.int/indicators/i/C071DCB/AC597B1