Obstetrics

Maternal mortality remains a global tragedy. Every minute a woman dies of pregnancy related consequences. 99% of these deaths occur in the developing world. The five most common causes of maternal mortality in the developing world would not lead to death if treatment was provided in time. Simple and inexpensive medical technologies to prevent or treat these complications have been available for over half a century.

The main causes of maternal mortality in women are:

Haemorrhage; accounts for a quarter of all maternal death. A woman, even in good health, who haemorrhages just after giving birth can die within two hours, especially if she is left without obstetric care. Haemorrhage can be prevented and treated using medications such as oxytocin.

Septicaemia; or general infection, is the main cause of death after delivery. WHO estimates that 76,000 women, or 15%, die of this type of infection, particularly in developing countries. One in 20 women giving birth develops an infection requiring antibiotics to avoid potential fatalities.

Eclampsia; is the world’s third most common cause of maternal mortality. This is linked to hypertension and happens at the end of pregnancy. It can lead to seizures, coma and death. According to the WHO, there are approximately 70,000 cases of eclampsia each year in the 143 least developed countries in the world. Convulsions related to eclampsia can be prevented and treated using the drug Magnesium Sulfate.

Unsafe abortion; refers to the termination of an unintended pregnancy either by persons lacking the necessary skills or in an unhygienic environment or both. It is responsible for 13% of all maternal mortality or 68,000 deaths each year. One woman dies every six minutes from unsafe abortion. Of those who live, many suffer serious consequences such as infertility or complications with future pregnancies. Comprehensive sexual and reproductive health care services can greatly reduce the number of unsafe abortions by offering safer alternatives through family planning and by identifying and treating complications during pregnancy early on.

Obstructed labour; (dystocia) is another leading cause of death and infirmity, particularly in Sub-Saharan Africa and South-East Asia. It can also cause rupture between the vagina-bladder wall and/or the vagina-rectum wall (obstetric fistula). Obstructed labour can be managed if it is identified early by following correctly a woman in labour and intervening with drugs like oxytocin at the appropriate moment. Interventional deliveries such as vacuum, forceps or caesarean sections can likewise prevent significant death and disability resulting from prolonged obstructed labour.

: © Henk Braam
In the Sri Lankan town of Killinochchi, rebel-held territory, MSF is supporting paediatric and emergency obstetrics care in the general hospital.

The pathologies that kill women during their pregnancies, deliveries or just after birth are the same throughout the world. What makes the difference is access to quality health care. It is simply the availability of affordable and effective treatment in developed countries that prevents these conditions which continue to kill pregnant women in developing settings.

"To prevent this death and suffering , all that women need is the supervision of trained medical staff during pregnancy and delivery, and access to emergency medical care in the event of complications," explains Christine Lebrun, Head of Reproductive Health Programmes at Médecins Sans Frontières.

Yet, whilst the global percentage of deliveries assisted by qualified staff worldwide is 61%, this drops to 34% in less developed countries. This is even less in Somalia and Ethiopia (23%) and worst in Haiti (5.6%).

It is worth noting that in many countries and for a multitude of reasons, women deliver at home. In fact, only 40% of deliveries worldwide take place in medical structures. And in the countries where home-birth is most common, maternal mortality is the highest.

As Médecins Sans Frontières is often the only health provider in a region, women frequently have to travel long distances to reach us, and they may not commence this journey until complications have already developed. In Ituri, for example, (in the east of the Democratic Republic of the Congo), more than one third of the 200 deliveries taking place each month in the maternity ward of the Bon Marché hospital present with complications such as haemorrhage or eclampsia.

This is also the case in Malakand, a remote rural area in Pakistan’s north-west province on the border with Afghanistan. Here Médecins Sans Frontières has observed delays in the decision to consult a health facility, which is first of all up to the traditional midwife and then the husband. Then there are the distances involved in reaching a health centre in this mountainous, isolated area, and the lack of available transport. Finally, the lack of quality care dispensed in certain public structures further exacerbates delays in providing care to meet women’s needs.

Médecins Sans Frontières' approach to reducing maternal mortality

Other obstetrics issues

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