Safe Childbirth: Why Do Women Die in Childbirth, and What You Can Do About It?
16 September 2021
The most common individual causes for maternal mortality worldwide are: haemorrhage (27.1%), hypertensive disorders (14.0%), sepsis (10.7%) and unsafe abortion (7.9%) (1). Of course, the distribution of maternal deaths is not equal across the globe. For example, 661,000 women died of haemorrhage between 2000 to 2017, but 659,000 of these deaths happened in developing regions. In fact about 94% of all mothers who die, do so in low and lower middle-income countries (2).
The distribution is also not equal across age groups. While in the UK it is often older women who worry (and are worried) about childbirth, globally it is adolescents aged 10-14 who face the highest risk of complications and death (2).
We can consider “sharp end”, at the point of care, causes and “blunt end” systemic causes for maternal mortality.
At the sharp end, women’s lives can be saved by a functioning healthcare system which is able to prevent and treat bleeding, infection and hypertensive disorders.
At the blunt end, women’s lives can be saved by access to contraceptives and safe abortions, and by ensuring women have control over their own bodies.
Women’s lives would also be saved by reducing poverty and war. In terms of poverty, two-thirds of all global maternal deaths in 2017 occurred in Sub-Saharan Africa (2). This same region is home to 27 out of the 28 poorest countries in the world. (3) Maternal mortality is higher in fragile states, many of whom are undergoing armed conflict.
It is not all bleak. The maternal mortality rate in most countries is reducing. In less-developed countries it dropped by half between 2000 and 2017 (2). There is still however a long road ahead and too many women dying from preventable causes.
What you can do:
- Donate to GiveDirectly, a “top charity” as rated by givewell.org. GiveDirectly gives approximately £83 out of £100 received directly to very poor families who use the cash to improve their lives (4).
- Find out who your MP is and write to them. Encourage them to allocate money to reducing maternal mortality and to reverse cuts to overseas aid, including an 85% cut to the United Nations global family planning programme. (5) Also encourage them to support debt relief for the poorest countries in the world.
1) Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. The Lancet global health. 2014 Jun 1;2(6):e323-33.
2) World Health Organization. Maternal mortality. 19th Sep 2019. https://www.who.int/news-room/fact-sheets/detail/maternal-mortality Accessed 3rd Sep 2021.
3) World Bank. Poverty and shared prosperity 2018: Piecing together the poverty puzzle.
4) GiveWell. GiveDirectly. https://www.givewell.org/charities/give-directly Accessed 3rd Sept 2021.
5) BBC News. Foreign aid: UK cuts its pledge to UN family planning by 85%. 29th Apr 2021. https://www.bbc.co.uk/news/uk-56924128 Accessed 3rd Sep 2021.
A UK Perspective
While the global maternity mortality ratio is 211/100,000, in the UK it is much lower at 4.1/100,000. The most common causes in the UK are: cardiac disease (23%), blood clots (15%), mental health conditions (13%) and epilepsy and stroke (13%) (1).
In the UK, as globally, the maternal mortality ratios are improving, from 7.67 in 1985-87 to 4.1 in 2015-17 (1).
Unlike globally, it is not a lack of access to drugs or equipment which, at the sharp end, is contributing to maternal deaths. Rather the recommendations are mainly around processes and procedures such as epilepsy referral services and non-technical skills such as leadership, team working and communication. Poor patient safety culture has been found to have contributed to poor outcomes in some labour wards and maternity units.
At the blunt end we are once again looking at deprivation and race as a contributor to poor health. Women who live in the most deprived areas are almost three times as likely to die as women in the least deprived areas (1). Black ethnic background women are more than four times as likely, and Asian ethnic background women more than twice as likely, to die than white women (1). While there are myriad reasons why non-white woman are more likely to die in childbirth, it is imperative that all in healthcare work hard to ensure that racism is not a contributor. As the Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MMBRACE-UK) report says:
further research is needed to fully understand the reasons for these disparities and hence to develop actions to address them.
What you can do:
- Encourage your local hospital to have training on safety culture, bullying, speaking up and learning from mistakes. Schwartz rounds can be used to help staff share experiences and feel supported in their work. (2)
- If you’re an appraiser, ask your obstetrics and gynaecology colleagues about their skills and drills training, and other training they do involving non-technical skills.
- Encourage your local hospital to have training on racism, intersectionality and bias.
- Find out who your MP is and write to them. Encourage them to decrease deprivation and address racism in the UK.
- Join the Equality Trust which works towards reducing socio-economic inequality in the UK.
1) Knight M, Bunch K, Tuffnell D, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JJ (Eds.) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2016-18. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2020.
2) The Point of Care Foundation. Schwartz Rounds. https://www.pointofcarefoundation.org.uk/our-work/schwartz-rounds/ Accessed 4th Sep 2021.
Written by Consultant Anaesthetist Michael Moneypenny
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