Maternal mortality and the role of primary care

10:33 10th December 2018 | Primary Care

The maternal mortality ratio for women experiencing complications in pregnancy and childbirth has declined significantly from 532,000 in 1990 to 303,000 in 2015. These improvements are particularly remarkable considering the rapid population growth in many of the countries where maternal deaths are highest. Still, over 800 women are dying each day from complications in pregnancy and childbirth and for every woman who dies, approximately 20 others suffer serious injuries, infections or disabilities. Almost all maternal deaths (99 percent) occur in developing regions.

Sub-Saharan Africa and South Asia account for 88 percent of maternal deaths worldwide. Sub-Saharan Africans suffer from the highest maternal mortality ratio of which is 546 maternal deaths per 100,000 live births, or 201,000 maternal deaths a year; this is two thirds (66 percent) of all maternal deaths per year worldwide. Regional and global averages tend to mask large disparities both within and between countries.

Every 10 minutes, one woman dies on account of pregnancy or childbirth in Nigeria, giving a total of 53,000 deaths per year; this means about 800 women die in every 100,000 live births.

The role of primary care

Almost all cases of maternal mortality are preventable. An estimated 74 percent of maternal deaths could be averted if all women had access to the interventions for preventing or treating pregnancy and birth complications. In many countries with high maternal mortality rates, there is a need to increase the provision of appropriate quality services.

Maternal mortality is overwhelmingly due to many interrelated delays which ultimately prevent a pregnant woman from accessing the health care she needs. Each delay is closely related to services, goods, facilities and conditions which are essential elements of healthcare. Since the majority of a woman's pregnancy is managed at a PHC level, it is crucial for practitioners to take note of the frequent delays that may be fatal to both the mother and child.

TYPE OF DELAY	CORRESPONDING ACTIONS
Delay in seeking appropriate medical help for an obstetric emergency for reasons of cost, lack of recognition of an emergency, poor education, lack of access to information and gender inequality.	· Access to health information and education · Access to affordable and physically health care · Enjoyment of the right to health on the basis of non-discrimination and equality
Delay in reaching an appropriate facility for reasons of distance, infrastructure and transport.	· Safe physical access to health care · Detailed referral protocols
Delay in receiving adequate care at a facility due to shortages in staff, or because electricity, water or medical supplies are not available.	· A sufficient number of health professionals · Availability of essential medicines · Safe drinking water, sanitation and other underlying determinants of health

In order to reduce the maternal mortality rate, the delays mentioned above need to be addressed. Prompt referral of complicated pregnancy or labour can prove to be a significant intervention. Though simple, knowing the limits of primary care is vital in the quest for safe motherhood.

Journal References:

1. Paul Hunt, Judith Bueno De Mesquita. Reducing maternal mortality, the contribution of the right to the highest attainable standard of health; published in conjunction with the European Union, UNFPA and the University of Essex. 2015
2. World Health Report, Maternal Mortality, WHO 2015