The World Health Organization (1992) has defined reproductive morbidity as consisting of three types of morbidity: obstetric, gynecologic, and contraceptive. (Obstetric morbidity is the equivalent of maternal morbidity.)
Obstetric morbidity—morbidity in a woman who has been pregnant (regardless of the site or duration of the pregnancy) from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
Direct obstetric morbidity results from obstetric complications of the pregnant state (pregnancy, labor, and the puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. This can include temporary conditions, mild or severe, which occur during pregnancy or within 42 days of delivery, or permanent/chronic conditions resulting from pregnancy, abortion or childbirth. Some chronic conditions (such as anemia or hypertension) may be caused by pregnancy and delivery, but are equally likely to have other causes.
Indirect obstetric morbidity results from a previously existing condition or disease, such as sickle cell disease or tuberculosis, which was aggravated by the physiologic effects of pregnancy. Such morbidity may occur at any time and continue beyond the reproductive years.
Psychological obstetric morbidity may include puerperal psychosis, at-
tempted suicide, strong fear of pregnancy and childbirth, and may be the consequence of obstetric complications, obstetric interventions, cultural practices (such as isolation during labor and delivery), or coercion.
Gynecologic morbidity—includes any condition, disease, or dysfunction of the reproductive system which is not related to pregnancy, abortion, or childbirth, but may be related to sexual behavior.
Direct gynecologic morbidity includes reproductive cancers, premenstrual syndrome (PMS), endocrine system disorders, bacterial or viral sexually transmitted diseases (STDs) and their sequelae (cervical cancer, pelvic inflammatory disease [PID], secondary sterility, AIDS), reproductive tract infections (RTIs), coital injuries.
Indirect gynecologic morbidity includes primarily traditional practices, some of which are for treatment of real or perceived gynecologic conditions (such as female genital mutilation, gishiri cuts).
Psychological morbidity includes psychological disorders associated with STDs, infertility, traditional practices, dyspareunia, fistulae, rape.
Contraceptive morbidity—includes conditions which result from efforts (other than abortion) to limit fertility, whether they are traditional or modern methods. Examples include menorrhagia from IUD use, thromboses from oral contraceptive use, and wound infections after Norplant insertion.
Maternal morbidity (or obstetric morbidity as defined above) can lead in turn to death. Death due to pregnancy-related causes is known as maternal mortality or maternal death. Maternal death is officially defined by the World Health Organization (1992:1238):
[T]he death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
WHO subdivides maternal deaths into two groups:
Direct obstetric deaths are those deaths resulting from obstetric complications of the pregnant state (pregnancy, labor, and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above.
Indirect obstetric deaths are those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiologic effects of pregnancy.
WHO defines two other specific types of maternal mortality. A late maternal death is the death of a woman from direct or indirect obstetric causes more than 42 days but less than 1 year after termination of pregnancy. A pregnancy related death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death.