Understanding Global Maternal Morbidity and Identifying Gaps in Global Research
By Saisahana Subburaj
What is maternal morbidity?
Maternal health outcomes are categorized, in order of increasing severity, as normal/healthy pregnancy, morbidity(often chronic), severe morbidity, and death. The WHO defines maternal morbidity as “any health condition attributed to and/or aggravated by pregnancy and childbirth that has a negative impact on the woman’s wellbeing.” While maternal mortality is studied frequently and often has updates on rates of prevalence, the exact global burden of maternal morbidity is not known. 15-20 million women worldwide are estimated to experience some form of maternal morbidity. The World Bank notes that maternal morbidity is disproportionately rising globally, affecting low- and middle-income countries(LMICs) more than high-income countries.1 Along with the limited focus on maternal morbidity, terminology surrounding classifications of maternal morbidity is not standardized. Acute maternal morbidities involve obstetric and maternal complications that occur anywhere from conception to 42 days postpartum. Severe acute maternal morbidities include life-threatening complications. Postpartum maternal morbidities are long-term physical or mental impacts from pregnancy, delivery, or management of other acute maternal morbidities. Lastly, chronic morbidities are not life-threatening but can be severely debilitating. Examples of each type of morbidity can be found in Table 1.
Table 1. Classifications of Maternal Morbidities and Examples
What are the causes of maternal morbidities?
Broadly, maternal health can be impacted by level of education, socioeconomic status, place of residence. Additionally, individual risk factors such as age, pregnancy frequency, access to facilities, support system or marital status, unintended pregnancies or unsafe abortions, ethnicity and religion, and nutritional factors such as obesity and comorbidities like diabetes, hypertension, cardiac issues, and anemia can also impact the health of a pregnant woman. The socioeconomic context like a women’s status, existing policies on sexual and reproductive health and rights, and conflict can influence maternal morbidities. Lastly, physical environments like the number, quality and distribution of skilled birth attendants, transportation, water quality, sanitation and hygiene services, and the quality of service in local health systems serve as determinants of health.
What are the outcomes of maternal morbidities?
When a mother’s health is impacted, the child(ren)’s and subsequently the family’s health is also affected. If the mother faces obstetric or maternal complications, the delivery outcome and neonatal morbidity will be affected. Adverse delivery outcomes, like NICU admissions, preterm birth, low birth weight, and fetal death, are often preventable with better care in terms of provider treatment, communication, and following evidence-based guidelines. Child development, low levels of education, and child survival also can be dependent upon maternal morbidities. If a mother suffers from a morbidity, she is likely to receive less social support and experience changes in her relationship in forms of violence and abandonment. Economic impacts such as productivity loss and impoverishment, physical outcomes such as infections from the existing morbidity, comorbidities, and changes in nutrition, and psychological issues such as depression can also affect a mother suffering from a morbidity.4
Global Maternal Morbidity
While the global discussion around maternal morbidities is poor, high-income countries are focusing more of their efforts on maternal morbidity along with mortality. This may be in part due to the lower prevalence of maternal mortality in high-income countries versus that of LMICs. That being said, the prevalence of some outcomes of maternal morbidities such as preterm births and fetal deaths are similar between high-income countries and LMICs. NICU admissions are higher in high- and middle-income countries probably due to the lack of NICU services in low-income countries. Sub-Saharan Africa and Asia have the highest prevalence of severe maternal morbidities at 198 per 1000 live births and 120 per 1000 live births, respectively. Globally, the leading contributors to maternal morbidities are hemorrhages and hypertensive disorders.1 To improve the health of mothers, and consequently children and families, maternal morbidities must be researched extensively and priority should be given to LMICs.
Global maternal morbidity is a global issue. Although its impacts are differential, every country still experiences cases of maternal morbidity. Many technological innovations are used to treat postpartum hemorrhage. Screening for risk of preeclampsia can serve as a primary prevention method. General interventions like fetal monitoring, proper hygiene, and nutritional supplements can also prevent maternal morbidities. Global efforts are necessary to reduce maternal morbidity worldwide.
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