Maternal Deaths Disproportionately High in Developing Countries

Claudio Shuftan

African women are 175 times more likely to die in childbirth than women in developed regions of the world

Geneva - New findings on maternal mortality by WHO, UNICEF and UNFPA show that a woman living in sub-Saharan Africa has a 1 in 16 chance of dying in pregnancy or childbirth. This compares with a 1 in 2,800 risk for a woman from a developed region. These findings are contained in a new global report on maternal mortality released today online by the three agencies as Adobe PDf file (40 pp. 733 kB) at:

Of the estimated 529,000 maternal deaths in 2000, 95 per cent occurred in Africa and Asia, while only 4 per cent (22,000) occurred in Latin America and the Caribbean, and less than one per cent (2,500) in the more developed regions of the world.

Experience from successful maternal health programmes shows that much of this death and suffering could be avoided if all women had the assistance of a skilled health worker during pregnancy and delivery, and access to emergency medical care when complications arise.

Many women deliver their children alone or with family members or other untrained attendants who lack the skills to deal with complications during delivery, said Dr LEE Jong-wook, Director-General of the World Health Organization. Skilled attendants are  vital because they can recognise and prevent medical crises and provide or refer for life-saving care when complications arise. They also provide mothers with basic information about care for themselves and their children before and after giving birth.

Reducing maternal mortality is a key factor in ensuring that all children, especially in the world's poorest countries, survive and thrive through adolescence.

These new estimates indicate an unacceptably high number of women dying in childbirth and an urgent need for increased access to emergency obstetric care, especially in sub-Saharan Africa, said UNICEF Executive Director Carol Bellamy. The widespread provision of emergency obstetric care is essential if we want to reduce maternal deaths.

The maternal mortality ratio, which measures the number of deaths to women per 100,000 lives births due to pregnancy-related complications, was estimated to be 400 per 100,000 live births globally in 2000. By region, it was highest in Africa (830), followed  by Asia - excluding Japan (330), Oceania - excluding Australia and New Zealand (240), Latin America and the Caribbean (190) and the developed countries (20).

Worldwide, 13 developing countries accounted for 70 per cent of all maternal deaths. The highest number occurred in India where 136,000 women died, followed by Nigeria where there were 37,000 deaths.

In 2000, world leaders agreed to reduce maternal mortality by three-quarters by 2015, as part of the Millennium Development Goals (MDGs). Tracking progress remains difficult, except where comprehensive registration of deaths, including causes of death, exists. For this reason, the use of indicators such as the proportion of women who have a skilled attendant at delivery is essential to track change.

The use of skilled attendants at delivery in developing countries increased between 1990 and 2000 from 42 to 52 per cent, suggesting a potential decrease in maternal deaths. Findings show the greatest improvements in South East Asia and Northern Africa and  the slowest change in sub Saharan Africa, which went from 40 per cent in 1990 to 43 per cent in 2000.

Most maternal deaths and disability occur as the result of one or more of three delays: a delay in recognizing complications; a delay in reaching a medical facility; or a delay in receiving good quality care. Efforts to address these delays are essential in  order to save the lives of mothers and babies.

Education on family planning and the provision of family planning services of high quality can also make a difference.

More lives could be saved if women had access to voluntary family planning to ensure that births are spaced properly, skilled attendance at delivery, and emergency obstetric care. UNFPA is committed to reducing the high levels of maternal death and disability that exist today, said Thoraya Ahmed Obaid, Executive Director of UNFPA.

The death of a mother during pregnancy or childbirth is a human tragedy at the individual, family and societal levels. The chances of survival not only of the newborn but also of the other children are substantially diminished when the mother dies.

As the focal agencies within the United Nations system for the health of women and children, WHO, UNICEF and UNFPA pledge to enhance - both individually and jointly in collaboration with their partners - their efforts in assisting countries strengthen their  maternal health programmes. (Source: Claudio Shuftan, AFRONETS 20 October 2003)