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Maternal morbidity: maternal deaths are just the 'tip of the iceberg'

Maternal morbidity: maternal deaths are just the 'tip of the iceberg'

Millennium Development Goal 5 sets out to [“Improve Maternal Health”](http://www.un.org/millenniumgoals/maternal.shtml) by 2015. To track progress on this target, researchers rely on maternal mortality ratios and rates of skilled birth attendance as indicators.

While these are important proxy measurements, maternal health is not the same as maternal survival. Indeed for every woman who dies from pregnancy-related causes, approximately [20 women](http://www.springerlink.com/content/b12w28508176n118/) develop maternal morbidities—illnesses and injuries that have a significant impact on their own health and that of their families and communities. Moreover, skilled birth attendance is not a panacea for achieving maternal health. One study in Bangladesh found that [40% of women](http://www.wilsoncenter.org/event/silent-suffering-maternal-morbidities-developing-countries) who had facility births experienced postpartum complications, and 7% suffered a severe obstetric complication. Clinical terms like ‘morbidity’ and ‘fistula’ are another way of saying ‘a lifetime marred by suffering and stigma’ in the case of postpartum depression, psychosis or obstetric fistula.

Maternal morbidities can be acute or chronic and include mental health issues, infertility, anemia, [fistula](http://ethiopia.usaid.gov/sites/default/files/Fistula_Fact_Sheet.pdf), infections, uterine rupture and scarring, and genital or uterine prolapse. Clinical terms like ‘morbidity’ and ‘fistula’ are another way of saying ‘a lifetime marred by suffering and stigma’ in the case of postpartum depression, psychosis or obstetric fistula. These conditions frequently stem from obstructed labor and they impact a woman’s ability to care for herself and her family. Often, maternal morbidities also result in financial hardship, stigma, social isolation, divorce and domestic abuse. And because women play a key role in care giving, food production and other economic activities, it is estimated that maternal morbidity costs the global economy [$6.8 billion annually](http://www.wilsoncenter.org/events/docs/Mary%20Ellen%20Stanton%20Presentation.pdf).

Last year, the Woodrow Wilson Center hosted an event on maternal morbidity in the developing world, and the resulting [report](http://www.tandfonline.com/doi/full/10.1080/17441692.2012.668919#tabModule) was published in March 2012. The authors conclude that to truly improve maternal health, maternal morbidity must be recognized as a critical component of safe motherhood, and researchers must prioritize data collection that tracks morbidity outcomes. Furthermore, they argue that access to affordable and acceptable health care before, during and after pregnancy is essential for preventing and successfully treating pregnancy-related injuries and illnesses. The solutions are the same: better, faster transport, more education on the danger signs of complications, drugs and training at the community level, removal of user fees, better training of midwives, a steady supply of key commodities.

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