Chapter 3. Levels and Causes of Maternal Morbidity and Mortality

In 2013, 289000 maternal deaths took place globally. Maternal mortality has declined by 45% between 1990-2013, and while considerable progress has been made particularly in recent years, it is now extremely unlikely that the goal of reducing maternal mortality by 75% will be met. Women face the higher risk of maternal death in South Asia and Sub-Saharan Africa. The most important direct causes are hemorrhage, hypertension, abortion, and sepsis; however, the proportion of deaths due to indirect causes is increasing everywhere and HIV has a big role to play for mortality in Africa. The most frequent complications are anemia and depression, but prolonged and obstructed labor has the highest burden of diseases because of disabilities associated with fistulas. The risk of maternal deaths has two components: the risk of getting pregnant, which is a risk related to fertility and its control or lack of control; and the obstetric risk of developing a complication and dying while pregnant or in labour. The obstetric risk is highest at the time of delivery. The chapter introduces what is known about the determinants of these risks as well as broader reproductive rights and inter-sectorial approaches. The acceleration of maternal deaths reduction will require improving quality of care in referral and primary health care facilities.