A Global Look at the Causes
One of the important goals of the Mary K Center is to share issues meaningful to all nurses worldwide and hopefully, distribute new research and evidence-based best practices that everyone needs to be aware of – regardless of the country.
Early in February, we announced that 2019 would spotlight an INSIGHT Series on maternal mortality, since this is a critical healthcare problem common to all countries. Our goal is to highlight the issues surrounding the problem and then what we as nurses, can do to help.
Today, we begin this series with a review of the causes and then next week we will summarize some of the strategies to reduce maternal deaths globally.
An article entitled Sustainable Development Goals and the Ongoing Process of Reducing Maternal Mortality, written by Lynn Callister, RN, PhD, FAAN, and Joan E. Edwards, PhD, RNC, CNS, FAAN, provides the content for both. Their article was published in the Journal of Obstetric and Neonatal Nurses (JOGNN, 2017, Volume 46, Issue 3), the publication of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWOHNN). We are deeply grateful for their willingness to share their findings with you. [LINK TO FULL PAPER]
Drs. Edwards and Callister described the enormity of the problem with maternal deaths by citing that 800 women die every day from pregnancy-related complications, which is approximately one woman every two minutes (Kassebaum et al, 2014).
Many causes account for these deaths, including:
- 27% hemorrhage
- 27% indirect causes (70% from pre-existing medical conditions)
- 14% hypertension
- 11% sepsis
- 10% other direct causes
- 9% abortion
- 3% embolism
The causes vary among countries as well as regions within countries. Accurate data are also difficult to get. In 2012, only one-third of nations had information on maternal/neonatal/stillbirth metrics.
Related Global Factors
Worldwide, maternal mortality rates are higher for girls less than 15 years old. Social determinants of health, such as poverty and lack of access to healthcare, greatly impact maternal mortality.
- Estimates are that more than half of maternal deaths occur in conflict-ridden and/or lesser-resourced countries (WHO, 2015b, p1.). This includes refugee women, as well as women in countries under siege.
- In India, Mozambique, South Africa, and Vietnam, pregnant women do not seek healthcare because of limited finances (Videler et al, 2016; Munquambe et al, 2016; Mmusi-Phetoe 2016; Corbett, Callister, Gettys, & Hickman, 2017).
- Some women may have limited autonomy because decisions are made by their families so cannot get permission to travel to get appropriate health care. (Moyer, Adongo, Hodgson, Engmann &Deuries, 2014, p. 109).
- Women simply can’t afford adequate health services (Qureshi et al., 2016; Vidler et al., 2016).
Equally alarming is research that shows the extent to which women who give birth in health care facilities suffer disrespect and abuse. There have been reports of physical, sexual and verbal abuse in different countries; these reports then discourage other women from seeking medical help for the birth of their child.
Healthcare Provider Issues
Unfortunately, there are also issues with the providers in certain parts of the world. Some still lack understanding of risk factors, including signs and symptoms of complications, preventive and proactive care for hemorrhaging and hypertension, as well as direct causes that can endanger the mother, fetus and neonate. Providers also do not always have effective medications, such as oxytocin, to treat and manage complications. What’s more, there is a reliance on legacy practices that are not evidence-based practices.
Immense Challenge, But Not Impossible
The need to deal directly with all these issues causing an unacceptably high rate of maternal mortality worldwide has been recognized locally, nationally and globally. In 2015, the United Nations and other world leaders agreed to implement the Sustainable Development Goals (SDGs), officially known as Transforming Our World: The 2030 Agenda for Sustainable Development as a means to continue to build upon the progress made through the Millennium Development Goals. It establishedGoal 3 as “Good Health: Ensure healthy lives and promote well-being for all at all ages. Target 3.1 is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.” (United Nations, 2015b)
This is not impossible. We can get there together. Next week we will continue our INSIGHT by showing the innovative programs that are being developed, also researched by Drs. Callister and Joan E. Edwards.
Lisa D. Cole, MA, RN
Director, Mary K Center for Global Nursing Development
MBF – Medical Benevolence Foundation
P.S. For the full article, please CLICK HERE and you will go to our Resource section, where the article is posted for your reference.