Sub-Saharan Africa Carries the Greatest Burden of Maternal Deaths
Sub-Saharan Africa carries the greatest burden of maternal mortality. It is the region with the highest maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births. According to estimates reported by the World Health Organization (WHO), Sub-Saharan Africa alone accounted for 62% of all maternal deaths globally in 2013. The same report indicated that the MMR in Sub-Saharan Africa is 510 compared to 140 in South-Eastern Asia, 85 in Latin America and the Caribbean, and 69 in Northern Africa. The rate of decline of maternal deaths has been slower in Sub-Saharan Africa than any other developing region. The majority of countries that made no progress or insufficient progress in meeting their Millennium Development Goal 5a targets of decreasing maternal mortality ratios by 75% by 2015were in Sub-Saharan Africa. It is of critical importance that the high maternal mortality in Sub-Saharan Africa be addressed.
Postpartum Care: The Often Neglected Aspect of Maternal Healthcare
The majority of maternal mortality cases occur in the often neglected postpartum period, defined as the time from 1 hour after delivery of the placenta to six weeks after delivery of the baby. The time of highest risk for maternal death is the immediate (first 24 hours) and early postpartum periods (days 2-7 after delivery). Life-threatening postpartum complications are often unpredictable and require rapid response. Postpartum care is essential for maternal health and survival because it enables skilled health providers, such as doctors and nurses/midwives to prevent potential postpartum problems, identify, and treat complications promptly.
The World Health Organization(WHO) recommends that postpartum care should be provided to mothers for at least 24 hours after birth in a health facility, and then at 48-72 hours, days 7-14, and six weeks after birth. Recommendations by the WHO on the content of postpartum care (for the mother) include physical assessment of the mother (vaginal bleeding, uterine contraction, fundal height, temperature, heart rate, blood pressure, urine void, etc.), counseling/information about the physiological process of recovery, iron and folic acid supplementation for at least three months, prophylactic antibiotics for women with third and fourth degree perineal tears, and psychosocial support. However, many women in Sub-Saharan Africa still do not receive any postpartum care. Percentages of women who do not receive any postpartum care after delivery in Sub-Saharan Africa remain very high, for example 74.1% in Uganda, 55.1% in Kenya, 55.2% in Nigeria, and 49.8% in Zambia. Obviously, these are missed opportunities for skilled health providers to prevent and detect any postpartum problems and complications in a timely fashion, and this can consequently lead to the death of a mother. Systematic and regular postpartum care is inadequate even for women who deliver in health facilities.
Call to Action
A need exists for more primary research on postpartum care provision and use in Sub-Saharan African countries. Research interventions during the postpartum period can decrease postpartum maternal mortality rates. To develop effective interventions that will decrease maternal mortality rates in Sub-Saharan Africa, it is critical to identify the key factors affecting postpartum care use, and understand challenges health facilities face in providing postpartum care. Research efforts must address access to care, especially for rural women. New research strategies are needed to ensure that mothers, especially those who are marginalized, have access to quality postpartum care services.
Trends in maternal mortality: 1990 to 2013. Estimates by who, unicef, unfpa, the world bank and the united nations population division. Geneva, Switzerland.
Zureick-Brown, S., Newby, H., Chou, D., Mizoguchi, N., Say, L., Suzuki, E., & Wilmoth, J. (2013). Understanding global trends in maternal mortality. International perspectives on sexual and reproductive health, 39(1).
Wang, W.J., Alva, S., Wang, S.X., & Fort, A. (2011). Levels and trends in the use of maternal health services in developing countries: DHS Comparative Reports. Calverton; USA: ICF Macro.
WHO recommendations on postnatal care of the mother and newborn. Geneva, Switzerland.