SUB-SAHARAN Africa still leads in the maternal mortality rates globally. It is followed by south-central Asia.
Recent findings by three top UN agencies show the life-time risk of dying in pregnancy or childbirth for a woman living in this part of Africa, which is one in 16, compared to one in 2,800 for women in the developed countries.
Women are most at risk during childbirth in Sierra Leone and Afghanistan where one out of six women will die from complications related to pregnancy and childbirth.
In India alone, 136,000 women die in pregnancy and childbirth every year.
Other high maternal mortality countries, in rank order, include Malawi, Angola, Niger, Tanzania, Rwanda, Mali and Somalia, the findings by the World Health Organisation (WHO), the United Nations Children’s Fund (Unicef) and the United Nations Population Fund (UNFPA) indicate.
The safest countries for delivering babies include Sweden, Iceland, Slovakia and Austria.
However, it is not easy to measure maternal deaths. This is so for both conceptual and practical reasons.
Maternal deaths are hard to identify precisely because they require information about deaths among women of the reproductive age, pregnancy status at or near the time of death, and the clinical cause of death.
All the three components may be difficult to measure accurately, particularly in settings where deaths are not comprehensively reported through the vital registration system and where there is no medical certification of cause of death.
WHO, Unicef and UNFPA have developed estimates of maternal mortality primarily with the information needs of countries with no or incomplete dates or maternal mortality in mind, but also as a way of adjusting for under-reporting and misclassification of data for other countries.
On the basis of estimate models, the number of maternal deaths in 2000 for the world was 529,000. Thus, because measuring maternal mortality is difficult and complex, reliable estimates of the dimensions of the problem are not generally available.
Sixty-two countries of the world have no maternal mortality data and they account for 27 per cent of global births. It is difficult to estimate rates and numbers for any cause of adult ill-health or death; maternal mortality is especially neglected because various reasons.
WHO says that even where vital registration of births and deaths is complete and all deaths are medically certified, maternal deaths are very frequently misclassified or simply missed.
Fort instance, in Britain, during the last five years national health planners and providers tried harder than ever to find the causes of all of the maternal deaths. They have recently added 50 per cent to the maternal mortality rate due to missing deaths alone.
Many such deaths are due to unsafe abortions (it is estimated at around 13 per cent) and these are often not counted because they happen in circumstances where the people often want to hide the reason.
The deaths happen in many places, including in the home, on the way to hospitals and at intensive care units where they are often not classified as maternal.
In addition to more than half a million maternal deaths every year worldwide, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease, which is approximately 10 million women per annum. Ninety-nine percent of these deaths occur in the developing world.
WHO says it is committed to achieving the Millennium Development Goals (MDG) of reducing by three-quarters, between 1990 and 2015, the number of women dying during pregnancy and childbirth.
The UN agency has called for intensified action in addressing threats to maternal health.
In this regard it will assist countries, especially those with high rates of maternal deaths to strengthen their health systems to build a “continuum” of care so that all women and their babies can go through pregnancy, childbirth and the postnatal period safely, irrespective of their ability to pay for these services.