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How many die or have complications?

Video highlighting the number of maternal deaths and the problem of maternal morbidity.
So in this step, we will look at how many die or have complications. And in order to understand this question, we need to consider the fertility aspect of maternal mortality, because without pregnancy, there are no maternal deaths or complications. So when looking at the global fertility, there are 210 million pregnancies each year, and around 140 million end in a live birth and 70 million end with a miscarriage, abortion, and stillbirth. Now I just want to take a second to mention that these numbers and the numbers throughout this course are updated regularly, and it’s always advisable to check the WHO website for the latest figures.
Given the large number of pregnancies, it’s not surprising that the problem of maternal deaths is large. A woman dies every other minute, day in and day out. But things are getting better and in other steps this week, we’ll explore this in more detail. Now looking at actual numbers, WHO reported that there were 289,000 maternal deaths in 2015. And out of these deaths, 99% were in low and middle income countries, and specifically in sub-Saharan Africa, which accounted for 66% or about 201,000 of the global deaths and Southern Asia, which accounted for 22%, or about 66,000. What’s shocking about this large number of deaths is that most maternal deaths are avoidable.
Looking at the data for maternal deaths in 2015, countries with the highest MMR, that is having an MMR greater than or equal to 800 deaths per 100,000 live births, were Sierra Leone, Central African Republic, Chad, and Nigeria. And two countries accounted for one-third of the global maternal deaths– that is Nigeria with about 19%, that is about 58,000, and India at 15%, which accounts for about 45,000. Now looking at the complication sides of things, as we mentioned earlier, the situation is improving with respect to maternal mortality. And since this is happening, we need to consider maternal morbidity more. Many more pregnant or recently delivered women survive a complication than die from the complication.
And some complications can lead to long-term disability, which can sometimes be very debilitating as in the case of postpartum depression. And because of this shift, there has been a major focus on severe maternal complications, including near-misses in recent years. There is an emerging interest on the economic and social impact of maternal morbidity. For example, the impacts of morbidity on the ability of women to work and on child development. We indicated in a previous step that the WHO definition of maternal morbidity does not just include the acute events, but also encompasses the negative impacts that it has on a woman’s life and well-being. So this negative impact can be physical.
So if there is no living child or a damaged pelvic structure, it can be social if they have to migrate, or there is isolation, or stigmatisation. There could be economic consequences if they’re in debt from it or they have no savings. And the psychological consequences, as well, so suicide or depression. And this diagram just shows the impacts that maternal complications have. So what proportion of pregnant women have a major complication? Well, the reality is that it’s hard to know how many pregnant women have a complication. But research has shown that around 0.8%, or 1.5 million pregnant women, have a near miss complication per year. This means that they nearly died during pregnancy, delivery, or the postpartum period.
And programme managers estimate that around 15%, or 29 million of all pregnant women, may develop serious complications that require rapid and skilled intervention. And this number has been used to determine the unmet or met needs for complications by looking at the number of women who access services in relation to the number of expected complications at population level. Additionally, if the five main direct obstetric causes of maternal mortality are included, there was an estimated 27 million morbid episodes in 2015.
But it’s really important to note that when estimating these numbers, a much higher percentage of women with morbidity is obtained when surveys are conducted and women report all of the symptoms they had during and after pregnancy, including things like backache, vomiting, nausea, et cetera.
So why is there an interest in near-misses? Well, they complement maternal deaths because they’re more frequent and it’s easier to obtain information about them. as the women themselves can be interviewed. Morbidities are also really close to deaths, so they have similar characteristics and also it’s a more positive event to investigate than death. And if we assume that near-miss cases need hospital care, then these events can be captured in a facility only. However, the disadvantage of studying near-misses are that the definitions are complicated and disputed. So in summary, there are a disproportionate burden of maternal deaths in developing countries. And maternal morbidity can have many physical, social, psychological, and economic consequences.
There are very large number of women that are unwell or severely sick as well during pregnancy.

The problems of maternal mortality and morbidity are large, but things are getting better.

What is the true size of maternal death, and who has the highest risk of dying? Why has there been a shift towards thinking about maternal morbidity, and what types of future consequences can maternal complications have for a mother?

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Improving the Health of Women, Children and Adolescents: from Evidence to Action

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