Pregnancy, childbirth, and motherhood are still deadly in much of the world. Here’s why

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A pregnant woman or new mother dies every two minutes – and most of these deaths are preventable, according to a new global analysis.

Worldwide in 2020, there were an estimated 287,000 maternal deaths, which occur anytime during pregnancy through six weeks after childbirth and are directly related to pregnancy, according to the World Health Organization (WHO).

Nearly all maternal deaths are in low-income countries, with women in sub-Saharan Africa and south Asia facing particularly high risks.

The new analysis is the WHO’s first global update in more than a decade on why these deaths are happening.

The findings offer clues on how to save the lives of pregnant women and new mothers in high-risk countries and around the world.

“The interventions, they’re not rocket science,” Dr Jenny Cresswell, a WHO scientist and the study’s lead author, told Euronews Health.

Between 2009 and 2020, the report found, the most common causes worldwide were haemorrhage – severe bleeding, usually during childbirth or immediately afterward – as well as preeclampsia and other issues related to high blood pressure, which can lead to stroke or organ failure if left untreated.

Health problems exacerbated by pregnancy, such as infections or chronic conditions, were another major driver, according to the study, which was published in the Lancet Global Health journal.

Other top causes included sepsis, blocked blood vessels, and abortion complications.

Few countries had data on maternal mental health problems, but the researchers said suicide is a key concern for women in their first year of motherhood.

Maternal deaths reflect broader problems

Maternal deaths are the “canary in the coal mine” that warn there are broader health, societal, and political problems, said Joyce Browne, an associate professor of global health and epidemiology at University Medical Center Utrecht in the Netherlands.

“If [they] have access to quality care, if the social determinants are well taken care of, women generally don’t die,” Browne, who was not involved with the study, told Euronews Health.

The higher risk of haemorrhage in lower-income countries, for example, reflects the “persistent inequities” in access to high-quality medical care during emergencies, the report said. Without it, women can bleed out and die within two hours.

Meanwhile, women in Latin America and the Caribbean are more likely to die from complications related to high blood pressure, which often occurs within the first week of childbirth.

Deaths also don’t tell the whole story. For every woman who dies around pregnancy or childbirth, many others suffer from a life-threatening complication known as a “near-miss”.

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In seven sub-Saharan African countries, for example, one in 20 women will experience a near-miss in their lifetime, a separate study found last year. That risk has been one in six in Guatemala.

“Mortality is the tip of the iceberg,” Cresswell said.

Boosting maternal health

Cresswell said the new findings underscore the need for more coordination between different parts of the health system, such as obstetrics, primary care, emergency services, and mental health support.

They also suggest that broader efforts to boost health systems in lower-income countries could pay off with better maternal health outcomes, she added.

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These gains may be incremental, Browne said. For example, international health guidelines say that when a woman is preparing to give birth, the baby’s heartbeat should be monitored every few minutes.

But in areas without enough medical staff, that may be feasible only once an hour – and that’s better than nothing.

Health workers “need to have practical guidance that assures that [they] do the best [they] can within the context [they] are, while [they] strive to do better in the future,” Browne said.

Notably, the study only includes data through 2020, meaning it doesn’t take into account how the COVID-19 pandemic strained health systems and workers across the globe.

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“We already know the situation is not progressing as much as we would like to see,” Browne said, adding that the US decision to slash global health programmes, including maternal and child health initiatives, injects more uncertainty into the future.

Despite the challenges, there has been some progress in recent decades.

Since the turn of the century, 69 countries have cut their maternal mortality rates by at least half. And as a region, sub-Saharan Africa reduced its rate by 33 per cent, according to the WHO.

“We have good data on why women are dying,” Cresswell said. “The important thing is to be investing in interventions and solutions to stop it happening again”.

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