The number of women dying from causes related to pregnancy and childbirth has fallen by 44% between 1990 and 2015, from approximately 385 to 216. But the figure came far below the target set by the United Nations as part of its millennium development goals in 2000, which aimed to see a drop of 75% by 2015.
The authors also reveal that about 27 million cases of serious pregnancy-related complications occurred in 2015 from the five main direct obstetric causes including haemorrhage and problems arising from abortions. “Death is the tip of the iceberg,” said Wendy Graham from the London School of Hygiene and Tropical Medicine “Morbidity is a very large burden on families and health systems.”
It is estimated that 210 million women become pregnant every year, with 140 million babies born. But according to the report provision of maternal healthcare worldwide is hugely variable. The chances of a woman dying from childbirth over her lifetime is about one in 4,900 in high-income countries, while for women in sub-Saharan Africa the figure is one in 36. By contrast, according to the World Health Organisation, the UK figure is one in 5,800. The situation can arise not only in low income countries, such as those in sub-Saharan Africa, but also in high- and middle-income countries due to social inequalities: black women were more likely to die in childbirth in New York in 2010 than women in North Korea or Vietnam.
“We still have large parts of low- income countries where there is a high unmet need for contraception.” said Wendy Graham. While births in the presence of skilled birth attendants rose from 57% to 74% between 1990 and 2013, the authors warn that many women in poor and rural settings do not have access to such care, while the increase in coverage does not necessarily mean such care is of high quality. “There are still about 53 million women who have no care at all at the time of delivery,” said Graham. “If you have coverage of care that is not good quality you are not going to prevent the deaths,” she added. “There is a non-trivial proportion of facilities that are called maternity units but don’t have running water, don’t have electricity, don’t have trained providers.”
“This is about human rights and a lack of standardised care across the world,” said Stephen Kennedy, head of the Nuffield department of obstetrics & gynaecology at the University of Oxford. “Women should be as healthy as possible before pregnancy and have access to adequate health care when they are pregnant,” he added. “There is then no reason why common problems in pregnancy shouldn’t be managed in exactly the same everywhere because the evidence base is so strong. We know what to do. The problem is that we are failing to implement that knowledge.”
The authors also of the over-medicalisation of birth that they dub “too much too soon”, as shown by high rates of caesarean sections and induced labour as well as unnecessary ultrasound examinations and excessive use of antibiotics. You have countries like Brazil and parts of Latin America where about 40% of deliveries are by caesarean section, they are a very common procedure,” said Graham. “Now there is no way that 40% of women need a caesarean section.” By contrast, around a quarter of babies in England and Wales are delivered by caesarean section, while almost 19% of births worldwide involve the procedure. “Globally, caesarean section rates are rising, and medically unnecessary caesarean sections are prevalent,” the authors report.