“The hand that rocks the cradle is the hand that rules the world”.
This is a famous poem from William Ross Wallace which praises motherhood as the preeminent force to change the world. But will this ever happen when death strikes right at birth? How can a mother ever rock her child when she dies even before she could even hear her baby cry? This may sound rhetoric, on the contrary, maternal mortality is indeed a serious problem the medical world especially in developing countries are beset.
The World Health Organization (WHO) defines maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
Generally, maternal death is distinguished between direct and indirect. Direct maternal death is the result of a complication of the pregnancy, delivery, or their management while indirect maternal death is a pregnancy-related death in a patient with a preexisting or newly developed health problem. However, there are also maternal deaths caused by accident or by domestic violence. But these two are more considered as “other causes” or incidental.
In the past, the issue on maternal death has not received much attention, but because of the alarming incidents reported especially in third world countries during the early part of this century, not only were the medical practitioners alarmed but the governments as well. The United Nations estimated global maternal mortality at 529,000, of which less than 1% occurred in the developed world in the year 2000. Another report revealed that there are approximately 27 maternal deaths per 100,000 live births each year in developed countries but in developing countries, the average is 18 times higher, at 480 deaths per 100,000 live births.
In 2003, the WHO, UNICEF and UNFPA produced a report with statistics gathered from 2000. The world average was 400, the average for developed regions were 20, and for developing regions 440. The worst countries were: Sierra Leone (2,000), Afghanistan (1,900), Malawi (1,800), Angola(1,700), Niger (1,600), Tanzania (1,500), Rwanda (1,400), Mali (1,200), Somalia, Zimbabwe, Chad, Central African Republic, Guinea Bissau (1,100 each), Kenya, Mozambique, Burkina Faso, Burundi, and Mauritania (1,000 each).
Medical practitioners have specified the major causes of maternal death and the top culprit is severe bleeding/hemorrhage which is 25%. This is followed by infections (13%), eclampsia (12%), and obstructed labor (8%). The report likewise indicated that 20% of maternal deaths are due to other indirect causes such as malaria, anemia, HIV/AIDS and cardiovascular disease, complicate pregnancy or are aggravated by it.
Despite the gravity of the problem, medical practitioners assured that at least half of all maternal deaths can be averted through a combined strategy of family planning, primary health care and legal abortion. Researchers also concluded that a fertility rate reduction of 25-35% resulting from more widely available family planning would also lower maternal mortality by 1/4. Making abortions legal and safe could reduce the toll an additional 20-25%. On the part of the governments, a number of steps have been charted. Among these is to make all pregnancies safer thru increased investments in prenatal health care and reducing the number of high-risk pregnancies which is foreseen to prevent another 20-25% of deaths. And to make everyone, not only medical practitioners but all concerned individuals aware of the rising maternal mortality, In 1998, WHO designated Safe Motherhood as the focus for World Health Day (April 7), indicating the importance of this issue globally.
And just as Wallace further said in his poem “Woman, how divine your mission Here upon our natal sod!” we must value our women and make them aware of their importance in this world.
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