Maternal morbidity: Neglected dimension of safe motherhood in the developing world

Abstract

In safe motherhood programming in the developing world, insufficient attention has been given to maternal morbidity, which can extend well beyond childbirth. For every woman who dies of pregnancy-related causes, an estimated 20 women experience acute or chronic morbidity. Maternal morbidity adversely affects families, communities and societies. Maternal morbidity has multiple causes, with duration ranging from acute to chronic, severity ranging from transient to permanent and with a range of diagnosis and treatment options. This article addresses six selected relatively neglected aspects of maternal morbidity to illustrate the range of acute and chronic morbidities that can affect women related to pregnancy and childbearing that are prevalent in developing countries: anaemia, maternal depression, infertility, fistula, uterine rupture and scarring and genital and uterine prolapse. Based on this review, recommendations to reduce maternal morbidity include: expand the focus of safe motherhood to explicitly include morbidity; improve data on incidence and prevalence of maternal morbidity; link mortality and morbidity outcomes and programming; increase access to facility- and community-based maternal health care and reproductive health care; and address the antecedents to poor maternal health through a lifecycle approach.

Birth attendance and magnitude of obstetric complications in Western Kenya: a retrospective case–control study

“…Examples of maternal morbidity are: anaemia (referred to earlier), maternal depression, infertility, obstetric fistula, uterine rupture and scarring and genital and uterine prolapse [12]. …”

Patterns and Determinants of Care-Seeking for Antepartum and Intrapartum Complications in Rural Bangladesh: Results from a Cohort Study

“…The actual burden of maternal complications during antepartum and intrapartum periods is not known; the literature provides varying estimates. For every maternal death, it is estimated that about 20 women experience acute or chronic complications due to maternal causes with substantial impact on physical, psychological, social and economic outcomes [4]. According to another estimate, approximately 15.0% of all pregnant women or about 20 million women annually around the world experience acute severe obstetric complications, including haemorrhage, pre-eclampsia, eclampsia, obstructed or prolonged labour, puerperal sepsis, and abortion [2, 5, 6].…”

What Are the Factors That Interplay From Normal Pregnancy to Near Miss Maternal Morbidity in a Nigerian Tertiary Health Care Facility?

“…As many as 15 million women are estimated to be affected by maternal morbidities worldwide (Koblinsky, Chowdhury, Moran, & Ronsmans, 2012). Hence, while maternal mortality has been described as the "tip of the iceberg," maternal morbidity constitutes the "base" but has not received adequate attention (Fortney & Smith, 1996;Hardee, Gay, & Blanc, 2012). As such, maternal morbidity and disability and their consequences have recently been described as the "neglected agenda in maternal health" (Koblinsky et al, 2012, p. 124).…”