Every day an average of 830 women die from pregnancy-related causes. Most of these deaths are preventable.
Many women across the world give birth without medical assistance. This massively increases the risks of complications or death, since the majority are preventable with appropriate care. The maternal health programs run by Doctors Without Borders/Médecins Sans Frontières (MSF) in more than 25 countries focus on reducing maternal and infant mortality through pregnancy and antenatal consultations, emergency obstetric care, postnatal follow-up, and access to family planning services.
Maternal health facts
The main causes of maternal mortality are hemorrhage, sepsis, eclampsia, unsafe abortion, and obstructed labor. Throughout pregnancy and especially during labor and delivery, skilled staff are able to quickly identify signs of these and other complications requiring further intervention, possibly including emergency care.
Hemorrhage, or severe bleeding, accounts for a quarter of all maternal deaths. A woman who hemorrhages just after giving birth can die within two hours, especially if she is left without obstetric care.
Sepsis, or general infection, is the main cause of death after delivery. One in 20 women giving birth develops an infection requiring antibiotics to avoid potential fatalities.
Eclampsia is linked to hypertension and is characterized by seizures that can lead to coma and death. Convulsions related to eclampsia can be prevented and treated using the drug magnesium sulfate.
Unsafe abortion refers to the termination of an unintended pregnancy by persons lacking the necessary skills, in an unhygienic environment, or both. Nearly half of all abortions worldwide are done in medically unsafe conditions, 90% of them in developing countries. Of the women who survive, many suffer serious consequences such as infertility, or complications with future pregnancies.
Comprehensive sexual and reproductive health care services can greatly reduce the number of unsafe abortions, by offering safer alternatives through family planning and by identifying and treating complications during pregnancy early on.
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 young and therefore has an underdeveloped pelvis, the birth canal itself is often not wide enough to accommodate the head of the baby.
An obstructed labor becomes prolonged, lasting longer than 24 hours. The woman is then at risk for postpartum hemorrhage.
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.
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.