Reviewing all maternal health-related policies frequently to ensure that they are internally coherent;. Enforcing standards on providers of maternal health services;. Any local solutions to problems discovered should be promoted, not discouraged. In terms of aid policy, proportionally, aid given to improve maternal mortality rates has shrunken as other public health issues, such as hiv/aids, have become major international concerns. 44 Maternal health aid contributions tend to be lumped together with newborn and child health, so it is difficult to assess how much aid is given directly to maternal health to help lower the rates of maternal mortality. Regardless, there has been progress in reducing maternal mortality rates internationally. 45 Epidemiology edit maternal deaths and disabilities are leading contributors in women's disease burden with an estimated 275,000 women killed each year in childbirth and pregnancy worldwide.
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Family planning approaches include avoiding pregnancy at too young of an age or too old of an age and spacing births. Access to primary care for women even before they become pregnant is essential along england with access to contraceptives. Policy edit The biggest global policy initiative for maternal health came from the United Nations' millennium Declaration 40 which created the millennium development goals. The fifth goal of the United Nations' millennium development goals (MDGs) initiative is to reduce the maternal mortality rate by three quarters between 19to achieve universal access to reproductive health by 2015. 41 The millennium development goals (MDGs) are eight international development goals that were officially established following the millennium Summit of the United Nations in 2000. Trends through life 2010 can be viewed in a report written jointly by the who, unicef, unfpa, and the world Bank. 42 countries and local governments have taken political steps in reducing maternal deaths. Researchers at the overseas development Institute studied maternal health systems in four apparently similar countries: Rwanda, malawi, niger, and Uganda. 43 In comparison to the other three countries, Rwanda has an excellent recent record of improving maternal death rates. Based on their investigation of these varying country case studies, the researchers conclude that improving maternal health depends on three key factors:.
The non-pneumatic anti-shock garment is a low-technology pressure device that decreases blood loss, restores vital signs and helps buy time in delay of women receiving adequate emergency care plan during obstetric hemorrhage. 36 It has proven to be a valuable resource. Condoms used as uterine tamponades have also been effective in stopping post-partum hemorrhage. 37 Public health edit On ierra leone launched free healthcare for pregnant and breastfeeding women Most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known. Improving access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth will reduce maternal deaths significantly citation needed. It is particularly important that all births be attended by skilled health professionals, as timely management and treatment can make the difference between life and death. To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. 38 Recommendations for reducing maternal mortality include access to health care, access to family planning services, and emergency obstetric care, funding and intrapartum care. 39 Reduction in unnecessary obstetric surgery has also been suggested.
Maternal death Surveillance and Response is another strategy that has been used to prevent maternal death. This is one of the interventions proposed to reduce maternal mortality where maternal l deaths are continuously reviewed to learn the causes and factors that led to the death. The information from the reviews is used to make recommendations for action to prevent future similar deaths. 35 Maternal and perinatal death reviews have been in practice for a long time worldwide and the world health guaranteed Organization (WHO) introduced the maternal and Perinatal death Surveillance and Response (mpdsr) with a guideline in 2013. Studies have shown that acting on recommendations from mpdsr can reduce maternal and perinatal mortality by improving quality of care in the community and health facilities. Medical technologies edit The decline in maternal deaths has been due largely to improved asepsis, fluid management and blood transfusion, and better prenatal care. Technologies have been designed for resource poor settings that have been effective in reducing maternal deaths as well.
34 Public health, technological and policy approaches are steps that can be taken to drastically reduce the global maternal death burden. Four elements are essential to maternal death prevention, according to unfpa. 3 First, prenatal care. It is recommended that expectant mothers receive at least four antenatal visits to check and monitor the health of mother and fetus. Second, skilled birth attendance with emergency backup such as doctors, nurses and midwives who have the skills to manage normal deliveries and recognize the onset of complications. Third, emergency obstetric care to address the major causes of maternal death which are hemorrhage, sepsis, unsafe abortion, hypertensive disorders and obstructed labour. Lastly, postnatal care which is the six weeks following delivery. During this time bleeding, sepsis and hypertensive disorders can occur and newborns are extremely vulnerable in the immediate aftermath of birth. Therefore, follow-up visits by a health worker to assess the health of both mother and child in the postnatal period is strongly recommended.
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Has the "highest rate of maternal mortality in the industrialized world." 27 In the United States, the maternal death rate averaged.1 maternal deaths per 100,000 live births during the years 19791986, 28 but then rose rapidly to 14 per 100,000 in 2000 and.8. 29 In 2013 the rate was.5 deaths per 100,000 live births. 30 It has been suggested that the rise in maternal death in the United States may be due to improved identification and misclassification resulting in false positives., proPublica and npr investigated factors that led to the increase in maternal mortality in the United States. They reported that the "rate of life-threatening complications for new mothers in the. Has more than doubled in two decades due to pre-existing conditions, medical errors and unequal access to care." 27 According to the centers for Disease control and Prevention,. 4 million women who give birth in the us annually, over 50,000 a year, experience "dangerous and even life-threatening complications." 27 According to a report by the United States Centers for Disease control and Prevention, in 1993 the rate of severe maternal Morbidity, rose from. Blood transfusions also increased during the same period business with "from.5 in 1993 to 122.3 in 2014 and are considered to be the major driver of the increase in smm.
After excluding blood transfusions, the rate of smm increased by about 20 over time, from.6 in 1993.0 in 2014." 32 Prevention edit The death rate for women giving birth plummeted in the twentieth century. The historical level of maternal deaths is probably around 1 in 100 two births. 33 Mortality rates reached very high levels in maternity institutions in the 1800s, sometimes climbing to 40 percent of patients (see historical mortality rates of puerperal fever ). At the beginning of the 1900s, maternal death rates were around 1 in 100 for live births. Currently, there are an estimated 275,000 maternal deaths each year.
18 These ten countries combined accounted for 60 of all the maternal deaths in 2010 according to the United Nations Population Fund report. Countries with the lowest maternal deaths were Greece, iceland, poland, and Finland. 21 Until the early 20th century developed and developing countries had similar rates of maternal mortality. 22 Since most maternal deaths and injuries are preventable, 7 they have been largely eradicated in the developed world. A lot of progress has been made since the United Nations made the reduction of maternal mortality part of the millennium development goals (MDGs).
Bangladesh, for example, cut the number of deaths per live births by almost two thirds from 1990 to 2015. However, the mdg was to reduce it. According to government data, the figure for 2015 was 181 maternal deaths per 100,000 births. The mdg mark was 143 per 100,000. 23 A further reduction of maternal mortality is now part of the Agenda 2030 for sustainable e target of the third Sustainable development goal (SDG) is to reduce the global maternal mortality rate (MMR) to less than 70 per 100,000 live births by 2030. Variation within countries edit There are significant maternal mortality intracountry variations, especially in nations with large equality gaps in income and education and high healthcare disparities. Women living in rural areas experience higher maternal mortality than women living in urban and sub-urban centers because 24 those living in wealthier households, having higher education, or living in urban areas, have higher use of healthcare services than their poorer, less-educated, or rural counterparts. 25 There are also racial and ethnic disparities in maternal health outcomes which increases maternal mortality in marginalized groups. 26 Maternal mortality in the United States edit main article: Maternal mortality in the United States The.
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18 Approaches to measuring maternal mortality includes civil registration system, household surveys, census, reproductive age mortality studies (ramos) and verbal autopsies. 18 Trends edit According to the 2010 United Nations Population Fund report, developing nations account for ninety-nine percent of maternal deaths with the majority of those deaths occurring in Sub-Saharan Africa and southern Asia. 18 Globally, high and middle income countries experience presentation lower maternal deaths than low income countries. The human development Index (HDI) accounts for between 82 and 85 percent of the maternal mortality rates among countries. 19 In most cases, high rates of maternal deaths occur in the same countries that have high rates of infant mortality. These trends are a reflection that higher income countries have stronger healthcare infrastructure, medical and healthcare personnel, use more advanced medical technologies and have fewer barriers to accessing care than low income countries. Therefore, in low income countries, the most common cause of maternal death is obstetrical hemorrhage, followed by hypertensive disorders of pregnancy, in contrast to high income countries, for which the most common cause is thromboembolism. 20 At a country level, India (19 or 56,000) and Nigeria (14 or 40,000) accounted for roughly one third of the maternal deaths in 2010 citation needed. Democratic Republic of the congo, pakistan, sudan, indonesia, ethiopia, united Republic of Tanzania, bangladesh and Afghanistan comprised between 3 and 5 percent of maternal deaths each.
Complications include hemorrhage, infection, sepsis and genital trauma. 15 by 2007, globally, preventable deaths from improperly performed procedures constitute 13 of essay maternal mortality, and 25 or more in some countries where maternal mortality from other causes is relatively low, making unsafe abortion the leading single cause of maternal mortality worldwide. 16 measurement edit The four measures of maternal death are the maternal mortality ratio (mmr maternal mortality rate, lifetime risk of maternal death and proportion of maternal deaths among deaths of women of reproductive years (PM). Maternal mortality ratio (mmr the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time-period. 17 The mmr is used as a measure of the quality of a health care system. Maternal mortality rate (mmrate the number of maternal deaths in a population divided by the number of women of reproductive age, usually expressed per 1,000 women. 17 Lifetime risk of maternal death: refers to the probability that a 15-year-old female will die eventually from a maternal cause if she experiences throughout her lifetime the risks of maternal death and the overall levels of fertility and mortality that are observed for. The adult lifetime risk of maternal mortality can be derived using either the maternal mortality ratio (mmr or the maternal mortality rate (mmrate). 17 Proportion of maternal deaths among deaths of women of reproductive age (pm the number of maternal deaths in a given time period divided by the total deaths among women aged 1549 years.
publication, sociodemographic factors such as age, access to resources and income level are significant indicators of maternal outcomes. Young mothers face higher risks of complications and death during pregnancy than older mothers, 12 especially adolescents aged 15 years or younger. 13 Adolescents have higher risks for postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants, all of which can lead to maternal death. 13 Structural support and family support influences maternal outcomes citation needed. Furthermore, social disadvantage and social isolation adversely affects maternal health which can lead to increases in maternal death. 14 Additionally, lack of access to skilled medical care during childbirth, the travel distance to the nearest clinic to receive proper care, number of prior births, barriers to accessing prenatal medical care and poor infrastructure all increase maternal deaths. Citation needed Unsafe abortion is another major cause of maternal death. According to the world health Organization in 2009, every eight minutes a woman died from complications arising from unsafe abortions.
British Medical Bulletin, 5 maternal death was first defined as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy. It is the definition still in use by the. World health Organization (WHO) defines maternal mortality as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management. According to the centers for Disease control, during the period 1974-75 in georgia, us, 29 of maternal deaths "occurred after 42 days of pregnancy termination and 6 occurred after 90 days post-partum." 5 severe maternal Morbidity (SMM) edit Although "severe maternal morbidity" (SMM) has become. 7 According to a june 2017 article published roles in the canadian Medical Association journal (cmaj) their working definition of "severe maternal morbidity and mortality" included "severe postpartum hemorrhage ( postpartum hemorrhage requiring transfusion obstetric shock, sepsis, cardiac complications ( cardiac arrest, cardiac failure, myocardial infarction. In a 2009 article on maternal morbidity, the authors said, that generally, there is a distinction between a direct maternal death that is the result of a complication of the pregnancy, delivery, or management of the two, and an indirect maternal death, 9 that. Fatalities during but unrelated to a pregnancy are termed accidental, incidental, or nonobstetrical maternal deaths. According to a study published in the lancet which covered the period from 1990 to 2013, the most common causes are postpartum bleeding (15 complications from unsafe abortion (15 hypertensive disorders of pregnancy (10 postpartum infections (8 and obstructed labour (6).
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Maternal death or maternal mortality is defined by the, world health Organization (WHO) as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated. 2, by 2017, the world maternal mortality rate had declined, but still every day 830 women die biography from pregnancy or childbirth related causes. According to the, united Nations Population Fund (unfpa) 2017 report, this is equivalent to "about one woman every two minutes and for every woman who dies, 20 or 30 encounter complications with serious or long-lasting consequences. Most of these deaths and injuries are entirely preventable." 3, unfpa estimated that 289,000 women died of pregnancy or childbirth related causes in 2013. 3, these causes range from severe bleeding to obstructed labour, 4 all of which have highly effective interventions citation needed. As women have gained access to family planning and skilled birth attendance with backup emergency obstetric care, the global maternal mortality ratio has fallen from 380 maternal deaths per 100,000 live births in 1990 to 210 deaths per 100,000 live births in 2013, and many. 3, high rates of maternal mortality still exist in places, particularly in impoverished communities with over 85 living in Africa and southern Asia. 3, the effect of a mother's death results in vulnerable families and their infants, if they survive childbirth, are more likely to die before reaching their second birthday. 3, contents, definition edit, according to a 2003 article in the.