Reducing Maternal Mortality: Steps to Reduce

What Is Maternal Mortality?

The World Health Organization (WHO) defines maternal mortality rate as the number of mothers who pass away during pregnancy or within the six weeks after a pregnancy is complete. The “completion” of a pregnancy can indicate either a delivery or an abortion. Maternal mortality does not include accidental or incidental deaths a mother’s death must be related to her pregnancy or a complication of obstetric care to be considered a maternal mortality.

Causes of Maternal Mortality

Maternal mortality refers to deaths due to complications from pregnancy or childbirth. These deaths are often preventable and result from a combination of medical, systemic, and social factors. Here’s a structured overview of the leading causes:

Medical Causes of Maternal Mortality

1. Hemorrhage (Severe Bleeding)
   • Most common cause globally
   • Often occurs postpartum due to uterine atony, retained placenta, or trauma
2. Hypertensive Disorders
   • Includes preeclampsia, eclampsia, and HELLP syndrome
   • Can lead to stroke, organ failure, or seizures
3. Infections
   • Postpartum sepsis, urinary tract infections, and chorioamnionitis
   • Often linked to poor hygiene or delayed treatment
4. Unsafe Abortions
   • Major cause in regions with limited access to safe reproductive care
   • Can result in hemorrhage, sepsis, or organ damage
5. Obstructed Labor
   • Prolonged labor without timely intervention
   • Can lead to uterine rupture or fetal death
6. Cardiac Conditions
   • Increasingly recognized in high-income countries
   • Includes congenital heart disease, cardiomyopathy, and thromboembolism
7. Chronic Medical Conditions Diabetes, anemia, HIV/AIDS, and malaria contribute significantly

Systemic & Social Contributors

• Lack of Prenatal Care
  Women without prenatal care are 3–4 times more likely to die from pregnancy complications
• Limited Access to Skilled Birth Attendants
  Especially in low-income and conflict-affected regions
• Delayed Recognition and Referral
  Late identification of complications and poor transport infrastructure
• Socioeconomic Inequities
  Poverty, education level, and rural residence increase risk
• Institutional Fragility and Conflict
  Countries in conflict or with weak health systems account for a disproportionate share of maternal deaths

Reducing Maternal Mortality

1. Universal Access to Skilled Care & Emergency Obstetric Services

• Ensure births are attended by skilled health professionals—a cornerstone in preventing maternal deaths. Timely intervention during complications is critical.
• Emergency obstetric care (e.g., managing hemorrhage, sepsis) alone could avert up to 74% of maternal deaths.

2. Strengthen Antenatal, Delivery & Postpartum Care

• Frequent antenatal visits—WHO recommends a minimum of eight contacts to improve outcomes.
• Focused postpartum care helps detect and respond to complications early.

3. Data Systems & Surveillance for Targeted Response

• Robust surveillance systems monitor trends, identify risk groups, and guide resource allocation.
• Improving health data quality ensures effective program evaluation and strategic planning.

4. Universal Health Coverage & Equity

• Inclusive reproductive, maternal, newborn care via universal health coverage helps eliminate access barriers.
• Addressing inequities—such as socio-economic disparities—is essential, as many maternal deaths are concentrated among marginalized groups.

5. Low-Cost, Life-Saving Interventions

• Non‑Pneumatic Anti‑Shock Garment (NASG): In trials across Egypt and Nigeria, NASG halved maternal mortality and drastically reduced hysterectomy rates.
• Postpartum hemorrhage interventions: A 2023 Nigerian study using blood‑loss measurement and pre‑packaged treatments cut severe complications by 60%, prompting WHO to update guidelines.
• Gates Foundation report: Highlights scalable interventions—such as intravenous iron for anemia and antibiotics to treat infections—to potentially save millions by 2030.

6. Community-Based & Grassroots Models

• Nigeria’s Abiye (Safe Motherhood) Project: A comprehensive system combining mobile health workers, free services, and referral coordination led to an ~85% reduction in maternal mortality between 2009–2016.
• Kenya’s TBA program: Training traditional birth attendants to recognize risk signs and encourage facility births increased hospital deliveries by 90%, substantially reducing deaths.
• Care Group approach: Community volunteers promote maternal and child health behaviors—cost-effective, sustainable, and scalable.
• U.S.: Doula support under Medicaid: In select states, doula involvement reduced hospitalization and C-sections by 8%, lowered preterm births, and cut costs.

7. System-Level Quality Improvement

• California’s Maternal Quality Care Collaborative (CMQCC): Implemented standardized protocols and hemorrhage response tools, reducing maternal mortality by 55% in just four years.
• India (Haryana state): Institutional deliveries, upgraded facilities, financial incentives, zero-home-delivery campaigns, and tracking high-risk pregnancies improved MMR from 106 to 89 per 100,000.

Global Initiatives Making an Impact

Most Effective Interventions

• Skilled birth attendance is the strongest predictor of reduced maternal mortality
• Community mobilization and education improve care-seeking behavior
• Health system reforms that prioritize maternal health in national budgets and policies

REFERENCES

1. Olea-Ramirez, L. M., Leon-Larios, F., & Corrales-Gutierrez, I. (2024). Intervention Strategies to Reduce Maternal Mortality in the Context of the Sustainable Development Goals: A Scoping Review. Women, 4(4), 387-405. https://doi.org/10.3390/women4040030
2. Howell EA, Ahmed ZN. Eight steps for narrowing the maternal health disparity gap: Step-by-step plan to reduce racial and ethnic disparities in care. Contemp Ob Gyn. 2019 Jan;64(1):30-36. Epub 2019 Jan 16. https://pmc.ncbi.nlm.nih.gov/articles/PMC6822100/
3. Bruce A. Scott, Amercian Medical Association, Specific steps we must take now to reduce maternal mortality, Sep 4, 2024, https://www.ama-assn.org/about/leadership/specific-steps-we-must-take-now-reduce-maternal-mortality

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

Connect with “Nurses Lab Editorial Team”

I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.