The truth about maternal death

Women die in childbirth at alarming rates. Maternal death is an excellent example of what the famous economist and philosopher Amartya Sen calls a "remediable injustice" —a condition that is fundamentally unfair and within our capacity to change.

Access to health services is better in more affluent, developed countries, so women die of pregnancy and childbirth-related complications at much lower rates than their counterparts in developing countries.

Better access to health services and skilled practitioners —nurses, midwives, medical doctors —is one of the keys to improving maternal mortality ratios in the developing world.

The Maternal Mortality Ratio (MMR) indicates the number of maternal deaths that occur for every 100,000 live births. In 2015, the world average was 216.

The highest MMRs are found in Sub-Saharan Africa (547) and in low-income countries (496). Conversely, the lowest rates of maternal death are found in high-income countries (10), the European Union (eight) and North America (12).

These numbers reveal much about the disparities that cause high rates of maternal death in poor countries and low rates in affluent countries. Resources are scarce in developing countries, and those that are available in the form of medical expertise, facilities and supplies are distributed unevenly.

According to the World Health Organization, the leading causes of maternal death include "haemorrhage, hypertension, infections, and indirect causes, mostly due to interaction between pre-existing medical conditions and pregnancy."

Most of these causes are treatable with simple procedures and medicines. Most maternal deaths are preventable if women have access to skilled providers and health clinics during pregnancy, childbirth and in the immediate post-partum period.

But the truth about maternal death is not that simple. While it's true that better access to health care before, during and after childbirth will reduce incidents of maternal death, there are other, more complex factors to consider.

Barriers to access to health services go beyond the lack of hospitals and doctors to implicate social and cultural dynamics. In other words, women struggle to access available resources due to the realities of poverty, racial discrimination, gender inequality and the criminalization of abortion.

Furthermore, women are vulnerable to complicated pregnancies through the practices of child marriage (and adolescent pregnancy), high fertility rates (which increases the potential for obstructed labour), patriarchal customs that make women's health, nutrition and education unimportant and policies that fail to respect human rights.

Unfortunately, this is not the case in North America, where MMRs have increased in recent years. In Canada, maternal death rates went from six in 1990 to 12 in 2010, likely due to an increase in caesarean sections, IVF births, older mothers and other health conditions.

The crisis in maternal health is the focus of broad global campaigns and detailed targeted initiatives. Much of this focus is devoted to generating increased attention and resources for maternal health.

However, global agencies and individual countries must do more to address the complex contextual factors that undermine maternal health.

Maternal death rates will only continue to decline if there are broad societal changes for all women. Governments play a leading role in perpetuating maternal death and will have to assume greater responsibility to reduce it.

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