A recent systematic review identified 34 datasets (35 197 maternal deaths) which were suitable for an analysis to examine the causes of maternal deaths in the developing world. The authors of this landmark review included Professor Khan of Ammalife, and the findings were reported in the Lancet. The review found wide regional variation in the causes of maternal deaths. Some of the main findings are:

Other findings from the above review, as well as findings of other relevant reports are summarised below.

More than 500,000 women die from pregnancy and childbirth, and 99% of these deaths occur in the developing world, where a lifetime risk of death from pregnancy and childbirth may be as high as 1 in 16, compared with about 1 in 10,000 in the developed world. The maternal mortality rate is estimated to be about 830 per 100,000 (almost 1 in 100 mothers) in sub-Saharan Africa, compared to 24 in 100,000 in Europe. To put these figures into context, a delivery suite such as the one at Birmingham Women’s Hospital where over 7000 babies are delivered each year, may be expected to sustain 70 dead mothers per year if it had a maternal mortality rate such as the one in Africa – that is more than 1 dead mother per week from pregnancy and childbirth – such rates will clearly be unacceptable in the developed world.

These figures represent the largest public health divergence in the world. However, this is in many ways only the tip of the iceberg, as it is estimated that a) around 20 million women a year are left with serious ill health or disability as a result of pregnancy and childbirth, b) millions of children are left motherless and c) an estimated one million young children die as a result of the death of their mother.

What are the causes of maternal deaths and disabilities?

It is estimated that approximately 80% of maternal deaths are due to Direct obstetric causes and 20% due to Indirect causes. The five leading Direct causes are postpartum haemorrhage, sepsis, pre-eclampsia and eclampsia, obstructed labour and abortion. Overall, these comprise around 80% of the deaths. The contribution from HIV and other infections such as malaria is also substantial in the developing world.

Joint distribution of causes of maternal deaths

The recent systematic review showed that haemorrhage was the leading cause of maternal death in Africa and Asia (>30% of deaths). Hypertensive disorders represent the highest cause of death in Latin America and the Caribbean. There was also wide variation within regions. Deaths due to hypertensive disorders and sepsis varied by development status. Compared with developed countries (reference group), sepsis was significantly more frequent in Africa, Asia, and Latin America and the Caribbean.

Other important regional differences included HIV/AIDS causing about 6% of deaths in Africa, and anaemia and obstructed labour each causing about a tenth of deaths in Asia.

Abortion related mortality was highest in Latin America and the Caribbean. Abortion-related deaths can exceed 30% in parts of Latin America and Eastern Europe.

Ectopic pregnancy was recorded as the cause in less than 1% of deaths in developing countries and almost 5% in developed countries.

The following links show further detailed statistics of causes of maternal deaths by regions and countries.