According to 1992 ICD-10 of WHO, maternal mortality refers to:
“The death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management; but not from accidental or incidental causes.” (pg 4)
Complication during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. According to WHO Global Health observatory data repository, the statistic on pregnancy related deaths are:
- Ethiopia: Decreased from 950 death per 100,000 live birth in 1990 to 350 death per 100,000 live birth in 2010
- India: Decreased from 600 death per 100,000 live birth in 1990 to 200 death per 100,000
- Canada: Increased from 6 death per 100,000 live birth in 1990 to 12 death per 100,00o live birth in 2010
- US: Increased from 12 death per 100,00 live birth in 1990 to 21 death per 100,000 live birth in 2010.
The possible factors of increase in pregnancy related death in US and Canada are:
- Intermittent insurance coverage of some mothers with underlying medical conditions in US
- Increase in older mothers
- Increase in chronic health conditions such as hypertension, diabetes and chronic heart disease
- Increase in obese and very obese mothers
- Increase in requested caesarian births
- Emerging infection (HIV/AIDS; H1N1 in 2009)
- Racial disparities
A delivery by cesarean section is a lifesaving procedure for pregnant women and their newborns who experience certain complications. It should be available everywhere as part of emergency obstetric care. However, while increased use of cesarean sections is associated with lower maternal and neonatal mortality, cesarean section rates above a certain level do not appear to have any benefit, and may in fact be dangerous for the mother and child. According to WHO, no more than 10–15% of births should be delivered by cesarean section; rates that are either much lower or much higher can be cause for concern. As with many advanced medical procedures, cesarean sections tend to be underused in developing countries and overused in developed countries. A recent study in developed countries found that both women’s and obstetricians’ choices influence levels of delivery by cesarean section, and that health system financing is the single most important factor driving these levels.
Considerable racial disparities in pregnancy-related mortality is seen in US. During 2006–2009, the pregnancy-related mortality ratios were:
- 11.7 deaths per 100,000 live births for white women.
- 35.6 deaths per 100,000 live births for black women.
- 17.6 deaths per 100,000 live births for women of other races.