Public Health Magazine: Winter 1995, Vol.5, No.1
Women's health takes center stage
Maternal Mortality: A Misunderstood Problem

There is a widespread myth that says maternal mortality and other pregnancy-related complications can be avoided with enough prenatal care, screening and education. But, according to Deborah Maine, director of the Prevention of Maternal Mortality Program at CSPH, most life-threatening obstetric complications can neither be predicted nor prevented.

In developed countries this misunderstanding is not a serious problem because it is possible to provide both antenatal care and treatment for obstetric complications to almost all women. However, in developing countries this is often not possible, and lack of prompt, adequate emergency obstetric care keeps maternal mortality high--30 to 100 times higher than in the United States.

"Any woman who is pregnant can develop obstetric complications," Maine said, "but treatment isn't readily available in many developing countries." So, while a woman having a breech delivery in the United States most likely will be able to undergo a Cesarean section, "in northern Nigeria you may well die."

Lack of blood, drugs and basic medical supplies make maternal mortality a much greater problem in developing than developed countries, said Angela Kamara, a nurse/midwife and from Liberia and deputy director of the Prevention of Maternal Mortality Program. In addition, Kamara noted, there are parts of Africa where women frequently live miles from treatment facilities that could save their life during a pregnancy-related complication. Finally, in some communities people do not recognize some complications as being abnormal or dangerous.

Many maternal deaths could be avoided, in fact, with a minimum of assistance. "In much of Africa, even teaching hospitals don't have basic drugs," Maine said. "Women die for lack of a couple of dollars worth of supplies or bleed to death for lack of sutures," she said.

"We have to make facilities available for the treatment of obstetrical complications," Maine said. "You have to fix up facilities, make sure people can get there and make sure people know when to use them. It's that more than anything else that makes the difference between developed and developing countries."

Since 1987, CSPH's Prevention of Maternal Mortality has collaborated with 11 interdisciplinary teams in West Africa to develop and test ways to improve access to and utilization of emergency obstetric care. Each team contains an obstetrician, a midwife, a community medicine specialist and a social scientist. The importance of this effort is underscored by its generous support from several major funding organizations, including the Carnegie Corporation of New York, the John D. and Catherine T. MacArthur Foundation, and the Andrew W. Mellon Foundation.