Critical Care Obstetrics
Preventing Maternal Morbidity & Mortality
An Educational Program from the Safe Motherhood Initiative
.US Maternal Mortality Today
On the rise?
.A Regional Look at Maternal Mortality Ratios* for the Year 2004
20.5 in all of NYS
15.9 in NYS
24.4 in NYC
*per 100,000 live births HP2010 Goal 4.3
each year some eight million of the estimated 210
million women who become pregnant, suffer life-
threatening complications related to pregnancy. in 2000,
an estimated 529,000 women died during pregnancy
and childbirth from largely preventable causes; 2.7
million infants are stillborn every year and three million
infants die within the first seven days of life. globally,
the maternal mortality ratio has not changed over the
past decade. Ninety-nine percent of all maternal deaths
occur in developing countries16
. Somalia has one of
the highest maternal mortality ratios in the world.
For maternal mortality progress has been even more elusive. Despite 15 years of the
Safe Motherhood Initiative, overall levels of maternal mortality are generally thought to have
remained unchanged, with the latest estimate of deaths standing at approximately 530,000 per
year (WHO, UNICEF et al. 2003). While a handful of countries have indeed experienced
remarkable drops in maternal mortality ratio (an indicator of the safety of childbirth and
pregnancy), in the great majority of high mortality countries, there has been little change.
One of the eight Millennium Development Goals (MDGs) that has made some progress, albeit
slow, is MDG 5: Improve maternal health. The two targets for assessing MDG 5 are reducing
the maternal mortality ratio (MMR) by three quarters between 1990 and 2015, and achieving
universal access to reproductive health by 2015. The United Nations (UN) Secretary-General
has launched the Global strategy for women’s and children’s health, to mobilize commitments
by governments, civil society organizations and development partners to accelerate progress
towards MDGs 4 and 5 (1).
World Development Indicators 2011, the 15th edition in its current format, aims to provide relevant, high-quality, internationally
comparable statistics about development and the quality of people’s lives around the globe. This latest
printed volume is one of a group of products; others include an online dataset, accessible at http://data.worldbank.
org; the popular Little Data Book series; and DataFinder, a data query and charting application for mobile devices.
The United Nations Millennium Declaration, signed by 189 heads of state in 2000, committed world leaders to achieving
Millennium Development Goal (MDG) 5, improving maternal health (with targets of reducing the maternal mortality
ratio—the number of maternal deaths per 100,000 live births—by three-quarters before 2015, and achieving universal
access to reproductive health). Although more than half of countries are reducing maternal mortality at an accelerated
pace, few are on track to achieve the goal by 2015.
Although there is no doubt that maternal
mortality is reducing, questions continue to be raised
about the exact figure for MMR, for example the
Bureau of Health Promotion retrospective study of
maternal mortality during 1995-1996 using RAMOS
approach (Reproductive Age Mortality Survey)
revealed a much higher figure than national figures
obtained from routine data. Estimates using the
RAMOS approach suggest the maternal mortality ratio
in 1991 was 44.3 per 100,000 live births and 43 per
100,000 live births in 1996.
About half of all deaths from unsafe abortion are in Asia, with most
of the remainder (44%) in Africa.
The unsafe abortion mortality ratio
(the number of unsafe abortion-related deaths per 100 000 livebirths)
varies across regions. For the developing world as a whole, this ratio
was estimated to be 60 in the year 2000. However, the ratio is much
higher in eastern, middle, and western Africa (90–140), and is lower
in northern and southern Africa, western and southeastern Asia, and
Latin America and the Caribbean (10–40).
The publication of this textbook marks a great milestone in our joint efforts at achieving
the Millennium Development Goal 5, which aims to reduce maternal mortality by
three-quarters, a daunting task indeed for most developing countries. The African
region, especially Eastern and Western Africa, has the highest ratio of women dying as a
result of pregnancy or childbirth in the world, estimated at an average of 1000 per
100 000 live births.
Indonesia’s maternal mortality is among the highest in the region, at an official ratio of 228/100,000. While this represents a decline from the ratio reported in previous years, it is far from the MDG target of 102/100,000 and an estimated 10,000 women die each year due to complications during labor and delivery. Most of these deaths are preventable. The leading causes of maternal mortality in Indonesia are hemorrhage (28%), eclampsia (24%), and sepsis (11%).
Professional care at birth can help
reduce maternal mor tality. The
proportion of women who deliver with
the assistance of a skilled health-care
provider - doctor , nurse, midwife - is
highly correlated with materna
Trends in this indicator during the 1990s
suggest that significant progress has
been made in developing countries, with
an overall increase from 41% to 57%
between 1990 and 2003. However ,
there are important differences across
regions, as shown in Figure 6.