Wednesday, 27 October 2010

Maternal mortality

In 2008, 1,000 women died every day from complications of pregnancy and childbirth: 570 in sub-Saharan Africa, 300 in South Asia, and 5 in high-income countries (WHO 2010).  The most common causes of death are bleeding, infections, high blood pressure, and unsafe abortions.

Maternal mortality ratio is the number of maternal deaths per 100,000 live births.  According to the World Health Organization, a maternal death is "the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management."  The definition of a live birth is basically a baby that shows any signs of life, from heart beat to muscle contraction.  This number represents the risk associated with pregnancy and delivery.

Maternal mortality ratio is one of the indicators that is used to asses health in countries around the world.  Countries with more resources, better education, and adequate health care have lower ratios than poorer countries.  In fact, this statistic shows one of the widest gaps between the rich and the poor.  Here are a couple of countries for comparison (WHO 2005 data):
Afghanistan = 1,800/100,000
Brazil = 110
Guatemala = 290
Haiti = 670
Ireland = 1 (the best place to have a baby)
Papua New Guinea = 430 --> 733 (should be orange on the map)
Sierra Leon = 2,100 (the worst)
Sweden, Greece, Italy = 3
United States = 11

There is a major problem with using maternal mortality or any other sort of statistic as a health indicator.  Calculation of such a number requires accurate records of births and deaths.  In a place like PNG, you are unlikely to find such information.  So I don't know how in the world they come up with the ratio.  This definition also does not account for the birth of a dead baby, as obviously it is not a "live birth."

In 2000, world leaders gathered at the UN in NYC and adopted the United Nations Millennium Declaration.  This Declaration was a partnership to reduce extreme poverty by the year 2015.  The Millennium Development Goals were designed with specific targets for reducing poverty.  Several of these focus on improving health-related indicators.  Target 5.A aims to reduce maternal mortality ratio by 75%.

So 10 years in to the Millennium Declaration, how are we doing?  Well, the world is actually doing better:  maternal mortality ratio declined by 34% from 1990 to 2008.  Good progress is being made but still a long way to reach the 75% goal by 2015.  PNG, on the other hand, is not doing so well:  the maternal mortality ratio has almost doubled from 430 to 733.  (Though I do wonder about the accuracy of the information.)  One of the contributing factors is that only 50% of women in PNG are delivered by a skilled birth attendant.  That means that the other half are delivering at home or in the bush or at a health center that doesn't have a nurse.  The mother might have an untrained friend or family member assisting her.  If there is an emergency, it is very difficult to get to help... mountain paths, bad roads, unreliable or no vehicles, rascals, distant health centers, etc.  You can probably see why our maternal mortality ratio is so bad.

During my 4 years of medical school, 3 years of residency, and one year of fellowship in the United States, I don't remember even hearing about a maternal death.  I can think of 4 since I came to PNG in early 2009.  The first was a mother with liver and kidney failure.  The second was a woman with heart failure.  In both of these cases, the pregnancy and delivery worsened the underlying illnesses in an already critical patient.  The third patient came to our hospital after laboring for several days at home.  The fetus was already dead when she arrived.  Mother had an infection, she was very sick with sepsis.  Her condition was complicated by a difficult delivery and post partum hemorrhage.  The combination of sepsis and hemorrhage damaged her kidneys and caused renal failure.  She died several days later.  Dai was the fourth.

With about 1,200 deliveries a year, that would make the maternal mortality ratio of Kudjip Hospital about 333 per 100,000 live births.  Though this number is higher than I would like, I remember countless faces of women who were saved because of the care that they received at our hospital!

"A woman giving birth to a child has pain because her time has come; but when her baby is born she forgets the anguish because of her joy that a child is born into the world."
~ John 16:21

1 comment:

  1. Stephanie, thanks for continuing to open our eyes to the human suffering that you see every day and that reflects what’s going on all over the world. It’s painful to read entries like these last two, but important to keep at the forefront of our Christian perspective. God loves each of these so much and knows exactly what they are going through. As Paul told the philosophers on Mars Hill, “From one man he made every nation of men, that they should inhabit the whole earth; and he determined the times set for them and the exact places where they should live.” Thank God that you are there to help them. It’s a privilege to participate with you in ministry.