Maternal Mortality

Definitions, Causes, and Distribution

Maternal mortality is death while pregnant or within 42 days of the end of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Up to 15 percent of all births are complicated by an unpredictable, potentially fatal, but usually treatable condition. If untreated, mothers, and often their babies, die.

The first 48 hours after delivery (or termination) are the most dangerous. Roughly 80 percent of deaths occur from direct, immediate causes of maternal mortality. Postpartum hemorrhaging is responsible for about one-quarter of all maternal deaths; if severe bleeding begins, a woman can bleed to death in two hours. Infections leading to blood poisoning, usually avoidable in sterile conditions, are the second leading cause; this was once known as childbirth fever. Preeclampsia results from high blood pressure during pregnancy and can result in fatal convulsions. Another frequent cause of death is obstructed labor, when the baby's head is too large for the mother's pelvis, or the baby is in an abnormal position. Complications from unsafe abortions also kill many mothers.

Maternal deaths do not occur randomly around the world. In some countries as many as 450 women die per 100,000 live births; in others, it is as low as 9 per 100,000. Ninety-nine percent of these deaths occur in the developing and poverty-stricken parts of the world. Even within wealthier countries, however, rates vary, and childbirth is more dangerous for poor women. For example, African American women in the United States are about three times more likely to die during pregnancy and childbirth than white women. Risk of death increases for mothers under age 20 and even more for mothers under the age of 15, and with each additional pregnancy. Other indirect causes of maternal death are more common among women in poverty; complications of malnutrition, anemia, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), or malaria also increase rates of dying during childbirth.

Estimates of maternal mortality, however, are of questionable accuracy. Experts expect that the problem is underreported; the poorest countries with the highest maternal mortality rates are also the countries with the most limited vital statistics data.

Historical Perspective

Throughout history, women have attended births, sat with the mother, and performed expected rituals. These midwives used their traditional knowledge to soothe mothers and birth babies; while they had no scientific methods for delivery, there is no indication that they did much harm. When physicians began delivering babies, they brought the medical, hospital model with them and, at first, high rates of childbirth fever.

During the early 20th century in the United States, for example, it was estimated that six to nine women died during 1,000 live births. This was largely due to inappropriate surgical techniques and lack of basic hygiene. Much of the credit for reducing these high death rates is given to a Hungarian physician, Ignaz Semmelweiss, who argued that physicians should wash their hands before attending a pregnant woman.

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