Maternal mortality

Issues surrounding maternal mortality have recently been widely published in both the lay media and the health fraternity literature. Possible reasons for this are that there are only five years remaining until the 2015 deadline to have achieved the United Nations Millennium Development Goals (MDGs). The general impression among health professionals is that there has been slow progress in achieving MDG 5 (maternal health), which targets a three-quarters reduction in maternal deaths from 1990– 2015. There have, however, been two recent publications, which are reflective of slow but significant progress in the reduction of maternal mortality in both high-and low-income countries. Last year, Hogan et al., using sophisticated mathematical models, estimated a total of 342 900 maternal deaths for 2008 in 181 countries, and a 1.8% rate of annual decline in mortality between 1990 and 2008. The authors showed a decline in maternal mortality ratios (MMRs) in both high-and low-income countries , except for some countries in sub-Saharan Africa and Asia. Fund and the World Bank issued the latest estimates on global MMRs. According to these estimates presented for 171 countries , approximately 358 000 deaths occurred worldwide in 2008. 2 The global maternal mortality ratio fell by 34%, with the biggest reductions occurring in eastern Asia and northern Africa (63 and 59%, respectively). It should be noted however, that the levels and trends varied widely within regions. Although there was a decline in some African countries, South Africa, Botswana, Swaziland, Kenya and Zimbabwe were estimated to have increased MMRs. The possible reason for the lack of reduction or increase in MMRs in these countries is probably the impact of HIV/AIDS. Overall, it was estimated that in 2008 there were 42 000 deaths among pregnant women due to HIV/AIDS. 2 In South Africa, the Saving Mothers report 2005–2007 indicated that non-pregnancy infections (mainly HIV/AIDS) are the commonest causes of maternal mortality. 3 The other major causes of maternal deaths in South Africa are shown in Table 1. Hypertensive disorders of pregnancy are the commonest direct causes of maternal mortality. Poorly controlled pre-eclampsia (both in the intra-and post-partum periods) are common avoidable factors. Besides HIV/AIDS, hypertensive disorders and obstetric haemorrhage, which are major causes of maternal deaths, some mothers are diagnosed to have medical conditions such as cardiac disease for the first time only in pregnancy. Detection of cardiac disease, cardiomyopathy, control of hypertension and diabetes, with proper advice on family …