26. Maternal and Perinatal Conditions

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Abstract

Richard Lord, www.rlordphoto.com

Maternal mortality and the neonate component of child mortality are particularly persistent health challenges in South Asia and Sub–Saharan Africa, which account for nearly all such deaths. Of the estimated 210 million pregnancies each year, close to 60 million end in death?most often of the baby, usually as a result of complications experienced by the mother. Maternal deaths are frequently caused by such conditions as hemorrhage, sepsis, hypertensive disorders, or obstructed labor, whereas perinatal deaths are usually attributed to low birth weight, birth asphyxia, or infection.

Maternal and perinatal conditions represent the single largest contributor to the global disease burden; thus, reducing the burden is an international priority. Interventions include population–based interventions to promote healthy behaviors and reduce mistimed pregnancies; nutritional interventions to address undernutrition or micronutrient deficiencies in women of reproductive age; and a continuum of care for mother and baby, including birth preparedness, involvement of the father, primary level care, access to emergency obstetric and hospital care, and delivery and postpartum care. The most successful interventions are those that are employed in combination.

Reducing maternal and perinatal mortality can produce a virtuous cycle of benefits: safe motherhood may help reduce poverty by freeing up resources otherwise diverted to health crises, which in turn stimulates economic activity, which then can feed back into improvements in maternal and perinatal health. In order for interventions to be cost–effective in developing countries, they need to focus on critical entry points to the health system, particularly primary care and prenatal care. Increasing the number of women in contact with these services is likely to lead to an increased proportion of deliveries with skilled attendance. Moreover, strategies to improve safe motherhood may be a means of achieving wider health service improvements.