Maternal health

Maternal health care provided at MSF's health center in Bidibidi, Uganda.
UGANDA 2017 © Frederic NOY/COSMOS
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Many women across the world give birth without medical assistance, massively increasing the risk of complications or death. Every day on average 830 women die from pregnancy-related causes. Most of these deaths are preventable.

99 percent
maternal deaths
occur in developing countries
50 percent
maternal deaths
occur during delivery or within 24 hours
1.1 million
births
assisted by MSF from 2013-2017, including 107,000 Caesarean sections

Reproductive health care is an integral part of the medical care Doctors Without Borders/Médecins Sans Frontières (MSF) provides, including in emergencies. Our maternal health programs in more than 25 countries focus on reducing maternal and infant mortality through pregnancy and prenatal consultations, emergency obstetric care, postnatal follow-up, and access to family planning services and safe abortion care.

Maternal health facts

Serious, untreated complications during pregnancy or delivery can be fatal to both mother and infant. The most common complications that may lead to maternal death are: postpartum hemorrhage, reproductive tract infections, eclampsia, unsafe abortion, obstructed labor, and serious infectious diseases.

Hemorrhage

Hemorrhage, or excessive bleeding, can happen after a complicated birth. Often it results from failure of the uterus to contract after delivery. Normally, these contractions stop the bleeding that occurs once the placenta separates from the uterine wall. But complications or incomplete placental separation can lead to continued bleeding, and without rapid medical intervention, a woman can quickly bleed to death.

When skilled birth attendants are present, oxytocin can be given to prevent bleeding. If severe bleeding does occur, the mother is resuscitated and attendants apply methods ranging from further medication and manual pressure to stop the bleeding through to emergency surgery.

Severe infection

Severe infection can develop during pregnancy or from unhygienic conditions during delivery. One common type is reproductive tract infections (RTI), which cause intrauterine infections that can eventually be fatal to the woman. They can also cause life-threatening infection in the infant.

Access to clean water and hygienic conditions during delivery, such as clean hands and a clean delivery surface like a plastic cover, are vital to preventing infections. If an infection occurs, early detection and treatment with the appropriate antibiotic can prevent serious illness or death

Eclampsia and other hypertensive disorders

Eclampsia and other hypertensive disorders of pregnancy are linked to high blood pressure and are characterized by seizures that can lead to coma and death. Eclampsia begins during pregnancy as pre-eclampsia, which leads to high blood pressure. Without prenatal care pre-eclampsia can develop into severe pre-eclampsia or full eclampsia, causing symptoms such as swelling, sudden weight gain, headaches, changes in vision, and potentially fatal convulsions.

Preventing and managing eclampsia is highly dependent on having access to obstetric care. Skilled birth attendants and essential drugs are vital for preventing eclampsia during labor, while convulsions can be prevented and treated using the drug magnesium sulfate.

Unsafe abortion

Unsafe abortion is a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills or in an environment lacking minimal medical standards, or both, as defined by the World Health Organization. Globally, at least 22,000 women die every year from unsafe abortion—the only major cause of maternal death that has not declined in recent decades, despite it being almost complete preventable. Of those women who survive, 7 million suffer serious consequences such as infertility, injury, or complications with future pregnancies.

Comprehensive sexual and reproductive health services can greatly reduce the number of unsafe abortions, by offering safer alternatives through family planning and access to safe abortion care.

Obstructed labor

Obstructed labor can occur if the baby’s head is too large or its position is abnormal, blocking passage through the birth canal. When a mother is malnourished or is very young and therefore has an underdeveloped pelvis, the birth canal itself is often not wide enough to accommodate the head of the baby. If an obstructed labor becomes prolonged, lasting more than 24 hours, the baby may die and the woman is at risk of postpartum hemorrhage, uterine rupture or fistula, and severe infection—all potentially fatal.

Skilled staff are essential in managing complicated deliveries and identifying signs that interventions are needed. These can range from IV fluids and/or medications to support labor, to an instrument-assisted delivery (vacuum cup or forceps) or caesarean section.

Indirect causes

Indirect causes, in particular complications from infectious disease, account for about 20 percent of maternal deaths.

During pregnancy, already dangerous diseases can pose even greater threats to both mother and fetus. For example, malaria in pregnant women increases their risk of miscarriage and causes over 10,000 maternal deaths globally, while tuberculosis also increases rates of miscarriage and maternal death. Malaria, tuberculosis, and cholera all raise the risk of stillbirths, death of newborns, or low birth weight infants.

For pregnant women at risk for any of these diseases, protecting their health starts with preventive measures. These can include reducing exposure (such as by sleeping under mosquito nets in malaria regions, and ensuring access to clean water and supplies for good hygiene) and short-term use of anti-malarial or anti-tuberculosis drugs during pregnancy. For those who become ill, early diagnosis and treatment are essential. Whether treating malaria, HIV, tuberculosis, or another disease, effective treatment reduces the risk of developing severe complications that threaten the lives of both mother and baby.

How MSF responds

Our obstetric care programs aim to remedy the crucial "three delays" that can threaten the lives of both mother and child. These are: delay in deciding to seek care; delay in reaching a health facility; and delay in receiving appropriate treatment at the facility.

Emergency obstetric care is a key component of this strategy. Emergency care administered promptly by qualified staff can save the lives of women experiencing complications during or just after delivery, when half of all maternal deaths occur. To help reduce barriers to use of our emergency obstetric services, we adapt services to local cultures and (as with all MSF programs) make them free of charge, as our beneficiaries are often among the poorest sector of the population.

During conflicts or natural disasters, where health services have often collapsed or are inadequate, emergency obstetrical needs are among the major needs we see. Over the period of 2008-15, 56 percent of all Caesarean sections we performed were in active conflict settings. For this reason, rapid implementation of emergency maternal care is now incorporated into our response to these crises.

We also aim to locate services close to the people who need them. In some settings where this is not possible or we serve a large region, we have introduced mobile clinics that travel to areas where people often have no access to health care, combined with referral systems to identify women with pregnancy complications and transfer them when necessary to a health post or hospital that can provide appropriate care.

In remote locations such as Kabezi, a rural district in Burundi, we have also implemented ambulance services, which have been linked to significant reductions in maternal mortality.

Antenatal care improves the mother’s health during her pregnancy and helps reduce or manage complications for both mother and newborn. In addition, these consultations provide opportunities to inform women and their families about how to recognize complications and to prepare for emergencies, and about health structures where women can go for emergency care, if needed, and for delivery.

Post-natal care is another critical area for reducing maternal and infant death and improving the physical and mental wellbeing of mother and child. Most maternal illnesses and deaths occur at or soon after delivery, while the majority of infant deaths occur in the first few days post-delivery—and 30 percent of all child deaths below the age of five occur in the first four weeks of life.

HIV/AIDS and preventing mother-to-child transmission

Without treatment, 25 to 40 percent of all children born to HIV-positive mothers will also be infected. This rate can be reduced to below five percent with antiretroviral treatments for the mother and a short course of antiretroviral drugs for the baby, together with appropriate breastfeeding practices.

We have opened programs on prevention of mother-to-child transmission in many of the world’s most affected regions. In Swaziland, for example, we provided HIV treatment to thousands of HIV-positive pregnant women as soon as possible after their diagnosis to prevent their babies from becoming infected.

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Care for other infectious diseases

Pregnant women are more susceptible to infectious diseases, and when infected they are more likely to experience pregnancy complications and face an increased risk of miscarriage or stillbirth.

For this reason, we offer preventive treatment to pregnant women exposed to diseases such as malaria and tuberculosis, and provide extra care where appropriate to pregnant women with these diseases or others such as cholera and hepatitis E.