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  • Title: Determinants of maternal mortality in the developing world.
    Author: Stokoe U.
    Journal: Aust N Z J Obstet Gynaecol; 1991 Feb; 31(1):8-16. PubMed ID: 1872781.
    Abstract:
    Maternal mortality is the culmination of a series of detrimental events in a woman's life, pregnancy being the last one. The underlying pathology is the lack of education, sanitation, accessible health care, as well as poor nutrition and poverty. These affect women during pregnancy and childbirth when they are more vulnerable. This 10-year review of literature from the developing world focuses on, and discusses the determinants of maternal mortality. Methods of reducing maternal mortality through policy addressing health care needs are touched on. Maternal mortality in developing countries is approximately 100 times that of developed countries: in this review after definition of terms and an estimate of prevalence, the causes of maternal death related to pregnancy are described, and medical, socioeconomic, demographic, and cultural factors leading to these deaths are presented, and finally approaches and policies that could prevent maternal deaths are discussed. Maternal mortality is any death of a women while pregnant or within 42 days of delivery caused by a related condition. The maternal mortality rate ranges from 40-2200/100,000 live births, but is unknown except from hospital series, which deal primarily with urban referral cases. The causes are hemorrhage, pregnancy-induced hypertensive disease, puerperal sepsis, uterine rupture, anemia, infection, non-medical abortion and poor management of delivery. Factors tending to increase maternal death include obstructed labor, malnutrition, poverty, overwork, lack of primary health care, parasitic disease. Cultural factors also promote maternal deaths in many areas, such as low status and neglect to girls and women, polygamy, early marriages and childbearing, underfeeding and dietary practices during pregnancy, and double standards of sexual ethics resulting in clandestine abortion or prepubertal marriage. Some approaches to reverse this tragedy include antenatal care with risk referral, small family norm, family planning, adult education, training and supervision of traditional birth attendants, maternity waiting homes, decentralized maternal-child health care, provision of legal, medical abortion, preferably contragestational agents and prostaglandins, blood banks at delivery units, standardized obstetric care, and compulsory education of girls and later marriage.
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