By Dr. Prem Misir

Maternal deaths are preventable; a remarkable and optimistic conclusion from the WHO, UNICEF, UNFPA and The World Bank in a study of maternal deaths in 181 countries for the years 1990 through 2010 (WHO, 2012).This study (WHO, 2012, p.1) showed that in 2010 there were 287,000 maternal deaths; with developing countries soaring at 284,000 (99%) of the total global maternal deaths, the bulk of which came from sub-Saharan Africa (162,000: 56%) and Southern Asia ( 83,000: 29%), with India (56,000: 19%) and Nigeria (40,000: 14%) consuming about a third of all maternal deaths; and with a 47% reduction in global maternal deaths between 1990 and 2010 , it is difficult not to conclude that the United Nations Millennium Development Goal 5 (MDG 5) which is to reduce maternal mortality ratio by 75% between 1990 and 2015 and to attain universal access to reproductive health, now appear improbable.

“This study (WHO, 2012, p.1) showed that in 2010 there were 287,000 maternal deaths; with developing countries soaring at 284,000 (99%) of the total global maternal deaths, the bulk of which came from sub-Saharan Africa (162,000: 56%) and Southern Asia ( 83,000: 29%), with India (56,000: 19%) and Nigeria (40,000: 14%) consuming about a third of all maternal deaths; and with a 47% reduction in global maternal deaths between 1990 and 2010 , it is difficult not to conclude that the United Nations Millennium Development Goal 5 (MDG 5) which is to reduce maternal mortality ratio by 75% between 1990 and 2015 and to attain universal access to reproductive health, now appear improbable.”

After the UN Secretary-General’s formulation of the MDGs 4 and 5, he installed the Commission on Information and Accountability for Women’s and Children’s Health (CIAWCH). This Commission noted that a major recommendation to enhance the measurement of maternal and child deaths is that “by 2015, all countries have taken significant steps to establish a system for registration of births, deaths and causes of death, and have well-functioning health information systems that combine data from facilities, administrative sources and surveys” (WHO, 2012, p.1); at that time, only about a third of the countries had an adequate civil registration system with accurate attribution of deaths.
Formulation of appropriate health policies to enhance maternal health would first require data to understand the causes of maternal death, and in this sense, a systematic review (Say et al., 2014) of maternal deaths which included an update of the aforementioned WHO study, was conducted; and it defined maternal death, thus: “the death of a woman whilst pregnant or within 42 days of delivery or termination of pregnancy, from any cause related to, or aggravated by pregnancy or its management, but excluding deaths from incidental or accidental causes” (WHO, 1992).
This systematic review (Say et al., 2014) examined 23 studies published between 2003 and 2012 from 415 datasets from 115 countries, analyzing 60,799 maternal deaths. This study found that between 2003 and 2009, direct obstetric causes produced 73% (1,771,000 of 2,443,000) of all global maternal deaths while indirect causes induced 27.5% of the global maternal deaths.
The major findings from this systematic review indicated that between 2003 and 2009, contributory causes for all maternal deaths were hemorrhage (661,000: 27.1%), hypertensive disorders (343,000: 14.0%), and sepsis (261,000: 10.7%); other contributory factors for all maternal deaths were abortion (193,000: 7.9%) embolism (78,000: 3.2%), other direct causes (235,000: 9.6%).
While Guyana is infinitesimally low in maternal death rates compared to the critical implications of increasing maternal death rates in sub-Saharan Africa and Southern Asia, health policy makers in Guyana must be mindful of the incidence of maternal deaths in this country. In redoubling efforts to improve maternal health, a vital area to start may be to review the system for registration of births, deaths and causes of death and at the same time ensure that the quality of the data is in compliance with the WHO standards. Globally, as indirect causes of maternal deaths are almost at 30%, quality of data becomes critical to identifying the indirect causes. There should be no excuse for complacency to promote maternal health.

References:
SAY, L., CHOU, D., GEMMILL, A., TUNÇALP, Ö., MOLLER, A.-B., DANIELS, J., GÜLMEZOGLU, A. M., TEMMERMAN, M. & ALKEMA, L. 2014. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health, 2, e323-e333.
WHO 1992. International statistical classification of diseases and related health problems (10th revision) World Health Organization, Geneva, Switzerland.
WHO 2012. Trends in maternal mortality: 1990 to 2010: WHO, UNICEF, UNFPA and The World Bank estimates, World Health Organization.