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Improving Birth Outcomes: Meeting the Challenge in the Developing World
Summary of Findings: Reducing Maternal Mortality and Morbidity in Developing Countries
More than half a million women, 99 percent of them in developing countries, die each year from pregnancy-related causes, a leading cause of death among women ages 15-49. The estimated lifetime risk of maternal mortality in some developing countries, where 1 in 11 women die as a result of pregnancy or childbirth, is 500 times that in some developed countries.
The five most significant direct causes of maternal mortality—hemorrhage, sepsis, unsafe abortion, hypertensive disease of pregnancy, and obstructed labor—together account for about two-thirds of all maternal deaths. Indirect causes, including preexisting conditions exacerbated by pregnancy, account for about 20 percent of maternal mortality.
With many maternal deaths occurring at home during childbirth, it is difficult to assemble clear epidemiological evidence that skilled attendance at delivery reduces maternal mortality. However, the overall association of skilled attendance with reduced maternal mortality, coupled with a knowledge of strategies that a skilled birth attendant can use to reduce both the incidence of complications and their severity constitute sufficient grounds to recommend that a skilled attendant assist every birth.
Significant reductions in maternal (as well as fetal and neonatal) mortality can be achieved if complications of childbirth are anticipated and addressed promptly by referral to a facility with the appropriate level of good-quality obstetric care. Access to higher-level care also requires a strong referral system that includes communication with, and transport to, referral facilities.