The Consequences of Maternal Morbidity and Maternal Mortality Report of a Workshop (2000) / Chapter Skim
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The Consequences of Maternal Morbidity and Maternal Mortality
The Consequences of Maternal Morbidity and Maternal Mortality
Pages 1-18
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From page 1... ...
In 1987 the global "Safe Motherhood Initiative" was launched by a group of international agencies at an international conference in Nairobi, Kenya, with the ambitious goal of reducing maternal mortality by half by the year 2000. The initiative has contributed much to knowledge of the causes of maternal morbidity and mortality and has been instrumental in advocating for improved access to health care for women, but the goal of halving the number of maternal deaths globally has yet to be achieved.
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Despite this potential confusion in interpreting the data, it seems clear that maternal mortality ratios are not declining at a rate that would achieve the 1987 goal for the year 2000. Continued high levels of maternal morbidity and mortality have consequences that affect women, their children, their families, and even their commu
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Workshop participants included policy makers, reproductive health program managers, representatives of international organizations, and researchers from demography, medicine, sociology, economics, public health, and population policy. Twelve presentations covered a range of topics related to maternal morbidity and mortality.
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The most frequent causes of maternal mortality are severe bleeding, responsible for 25 percent of the deaths; indirect causes, such as complications related to anemia, malaria, and heart disease, responsible for another 20 percent of maternal mortality globally; and infection or sepsis, responsible for 15 percent of the deaths (see Figure 2~. These numbers, which were published by the World Health Organization, are only best guesses, because there are no reliable population-based statistics on the causes of maternal mortality in most parts of the world, but they provide a general idea of the scope of the problem.
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Henry Mosley noted that the consequences of maternal mortality are extremely difficult to measure, because it is a relatively rare demographic event. For example, if the maternal mortality ratio is about 400 deaths per 100,000 live births, one would have to follow an average population of 500,000 annually for 5 years to observe 400 maternal deaths.
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Decreased Nutrition and Schooling for Children There are few available data on the effects of maternal deaths on children's overall welfare, but some research has looked at the effects of parental death on the nutritional status and schooling of children. Martha Ainsworth described her longitudinal study with Innocent Semali in the Kagera region of Tanzania, on the effects of parental death on children's nutritional status (Ainsworth and Semali, 1998~.
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Indirect Evidence: Consequences of Parental Mortality for Families and Society Although a woman's children may shoulder the greatest burden of their mother' s death, the entire family is likely to suffer. However, the overall consequences for society from maternal mortality alone are likely to be modest for two reasons: maternal mortality is a relatively infrequent cause of adult death in high mortality settings, and women' s measurable productive contributions in developing countries are often less relevant than the noneconomic benefits that she brings to her family.
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Over and Dayton found a pattern of death and poverty in the Kagera region of Tanzania, due to the AIDS epidemic there (World Bank, 1997~. Using logistic regression models, they examined household consumption following the death of an adult in comparison with consumption in households that did not experience an adult death.
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Households have a variety of techniques to cope with adult death, such as increased home food production. The poorest households suffer the most in terms of reduced consumption, so assistance programs that are targeted towards these households have the potential to be the most effective.
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EVIDENCE ON THE CONSEQUENCES OF MATERNAL MORBIDITY The World Health Organization estimates that 42 percent of the approximately 129 million women who give birth annually (according to the United Nations) experience at least mild complications during pregnancy (United Nations, 1999; World Health Organization, 1993~.
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Other injuries that can be caused by prolonged obstructed labor include renal failure, pelvic inflammatory disease, infertility, and neurological injuries, including a condition called foot drop caused by nerve damage to the lower spine (Arrowsmith et al., 1996~. Although surgical procedures can repair fistulas, many women in developing countries do not have access to this procedure.
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Wall, however, argued that female genital cutting has been overemphasized in connection with obstructed labor because the obstruction usually occurs higher up in the pelvic region. Instead, he emphasized the relatively low socioeconomic status of women in many African societies and the possibility that fistula patients may be more visible in areas with special treatment facilities, such as northern Nigeria and Addis Ababa.
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Gray hypothesized that a causal link between HIV and reduced fertility might be due to HIV itself or to a relationship between HIV and undiagnosed tubal infertility due to pelvic inflammatory disease (PID)
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. The maternal health risks associated with widespread mild anemia have not yet been established, but at moderate levels of anemia, work capacity is impaired due to a combination of reduced oxygen-carrying capacity and the negative effect of iron deficiency on muscle function (Yip, 1994~.
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Although the study results are promising, there were a few incongruous findings, and additional studies are needed in different settings to clarify the mechanism and confirm the role of vitamin A in preventing maternal mortality. Domestic Violence and Maternal Morbidity Jacquelyn Campbell discussed recent findings regarding abuse and its relationship to pregnancy, childbirth, and general reproductive health.
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There is little research on the social and economic effects of maternal morbidity particularly, but it is likely to have consequences that are similar to those of other adult illnesses and disabilities, about which some work has been done. Table 2 shows some of the potential social and economic effects that adult illness may have on the household, both directly and through the implementation of coping processes or efforts to reduce the direct impact.
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From page 18... ...
Preventing deaths by increasing access to essential obstetric care and also encouraging better nutrition, increased education, improving reproductive health, and expanding access to all types of health care and other services for all women is clearly a desirable objective. The Workshop on the Consequences of Pregnancy, Maternal Morbidity, and Mortality for Women, Their Families, and Society was obviously a starting point for looking at these interrelationships.
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