Care for pregnant women differs fundamentally from most other medical
endeavours. ‘Routine’ care during pregnancy and birth interferes in the
lives of healthy people, and in a process which has the potential to be
an important life experience. It is diffi cult to measure the extent to which
our efforts may, for example, disturb the development of a confi dent,
nurturing relationship between mother and baby. The harmful effects we
measure in randomised trials are limited to those we have predicted may
A study in Herat province concludes that the extraordinarily high number of deaths of
women during pregnancy and childbirth are largely preventable. They are a direct
consequence of the very young marriage age for women and girls (according to UNIFEM,
54% of girls under the age of 18 are married),12 poor health and nutrition, too-frequent
childbearing, and virtually no access to gynecological and obstetrical services.
Imagine the plight of a young woman, some time during the thousands of years before
the mid-18th century, who, soon after a diffi cult childbirth, fi nds she can no longer keep
from leaking urine. She is standing in the chill winter wind, her urine-soaked clothes
clinging wet against her thighs as she comforts her crying baby knowing that she faces
a life of misery, shame and social ostracism. Or imagine the middle-aged wife of a
tenant farmer on the remote central Illinois plain, straining with her husband to lift a
heavy log that has fallen on their only milk cow only to feel a deep...
The poor nutritional status of women in developing countries has been associated with
maternal mortality. Maternal deaths do not result from malnutrition alone, however, but
mainly from a lack of access to obstetric care and from previous conditions that may be
aggravated by poor nutrition.
It has been documented, for example, that high maternal pre-pregnancy weight and excessive
weight gain during pregnancy are often associated with adverse pregnancy outcomes,
including greater risks of gestational diabetes, childbirth complications, caesarean sections,
hypertension and pre-eclampsia, and post-partum obesity. Women with severe (morbid)
obesity are more likely to experience even poorer outcomes such as stillbirths or neonatal
In some countries, adolescents are less likely than adults to obtain skilled care
before, during and after childbirth.
WHO’s recommendations for increasing the use of skilled antenatal, childbirth and postpartum care are informed
by one graded study, one ungraded study, existing WHO guidelines and the collective experience and judgment of a
panel of experts. The studies were conducted in Chile and India. One intervention was a home visit programme for
adolescent mothers. Another was a cash transfer scheme contingent upon health facility births.
This interagency list is a tool to support planning for the selection, quality assurance and
procurement of medical devices to implement the Maternal and Newborn Health (MNH)
interventions, which are defined as the “Essential care to women and their newborn during
pregnancy, childbirth and postnatal period: up to six weeks after delivery.
Midwives and the care they provide to women, babies and families are
of the utmost importance to society. Across the United Kingdom
midwives are key professionals in ensuring that women have a safe and
emotionally satisfying experience during their pregnancy, childbirth and
The coming decade will present new challenges and opportunities for
midwives to develop further their role as practitioners, partners and
leaders in delivering and shaping maternity services.
Complications during pregnancy and
childbirth are a leading cause of death
and disability among women of
reproductive age in developing
countries, killing over half a million
women in 2000 and causing disability
and suffering among many millions
more. In 2000, half of these deaths
(251 000) occurred in Africa, about
48% (253 000) occurred in Asia, about
4% (22 000) in Latin America and the
Caribbean, and less than 1%
(2 500) in the more developed regions
of the world.
Universal access to reproductive health
care, including family planning, is the
starting point for maternal health.
In developing countries, a mother’s death in
childbirth means that her newborn will almost
certainly die and that her older children are more
likely to suffer from disease.Moreover, when
mothers are malnourished, ill, or receive inade-
quate care, their newborns face a higher risk of
disease and premature death.
9 Almost one-quar-
ter of newborns in developing countries are born
low birth weight, largely due to their mothers’
poor health and nutritional status, which results
in increased vulnerability to infection and a high-
er risk of developmental problems.