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Maternal morbidity

Mother and baby, India

Women suffer significant ill health during and after pregnancy, which is largely unrecognised. For every woman that dies, 20-30 suffer morbidity related to pregnancy and childbirth.

Women suffer significant ill health during and after pregnancy, which is largely unrecognised. For every woman that dies, 20-30 suffer morbidity related to pregnancy and childbirth. Maternal mortality and morbidity are highest in low and middle-income countries (LMICs). Maternal morbidity includes any condition attributed to or aggravated by pregnancy and child birth, which has a negative impact on the woman’s well-being.

The priority of the international community is to reduce the global maternal mortality rate to less than 70 per 100,000 live births by 2030. The number of women who die, however, represent the tip of the iceberg, with maternal morbidity as the base.

Currently, there is a lack of understanding of the type and extent of ill-health women suffer most. There is no means to measure maternal morbidity that is comprehensive, standardised and comparable across different settings.

Antenatal and postnatal care packages in LMICs do not address the needs of women in a comprehensive holistic way. General medical conditions, depression and domestic violence should be assessed. Anaemia and early sepsis represent a large burden of ill health and may be useful clinical markers or proxy measures for maternal morbidity.

Measuring women’s health during and after pregnancy

CMNH conducted a study of maternal morbidity in India, Kenya, Malawi and Pakistan. The cross-sectional study assessed women at five stages of pregnancy:

  • Early natal (<20 weeks)
  • Late natal (>20 weeks)
  • At birth (within 24 hours of delivery)
  • Early postnatal (day 1-7)
  • Late postnatal (1-12 weeks)

Socio-demographic factors, subjective (self-reporting) and objective (clinical examination and investigations) health outcomes were assessed. Relationship between ill health and maternal characteristics were investigated using logistic regression analysis.

A total of 11,453 women were assessed in India (2,099) Malawi (2,923) Kenya (3,145) and Pakistan (3,286). Overall, the findings were:

  • 20% were depressed, reported poor quality of life and poor satisfaction with health
  • 76% reported more than one physical symptoms, the commonest gastrointestinal 
  • 47.4% were anaemic
  • 32.2% had clinical signs of early sepsis