In 2015, an estimated 303,000 women died as a result of pregnancy and childbirth-related complications (WHO 2015a). Most of these deaths occurred in low- and middle-income countries (LMICs). Sub-Saharan Africa had the highest maternal mortality ratio (MMR) in 2015, an estimated 546 maternal deaths per 100,000 live births; the MMR for high-income countries (HICs) was an estimated 17 maternal deaths per 100,000 live births (map 7.1) (WHO 2015a). Although significant progress has been made since 1990 in achieving the Millennium Development Goals (MDGs), with a reduction in the global MMR from 385 to 216 maternal deaths per 100,000 live births, this reduction falls short of the 2015 MDG 5 target of a 75 percent reduction.
Similarly, mortality for children under age five years (MDG 4) declined by 49 percent, from 12.4 million in 1990 to 5.9 million in 2015, but still substantially short of the 2015 target of a reduction by two-thirds, and the decline is much slower for neonatal deaths (Liu and others 2016). Within countries, when the population is disaggregated by income, education, or place of residence, wide disparities in child mortality can be shown, even in those areas where the overall mortality seems low. Respiratory infections, diarrhea, and malaria remain important causes of under-five mortality after the first month of life (Liu and others 2016). Neonates account for 45 percent of all deaths under age five years (Liu and others 2016); this share exceeds 50 percent in several regions (Lawn and others 2014). Of all newborn deaths, preterm birth and intrapartum-related complications account for 59 percent (Liu and others 2016), and preterm birth is now the leading direct cause of all deaths under age five years (Lawn and others 2014).
The tracking of progress does not include stillbirths. In 2009, an estimated 2.6 million stillbirths occurred in the last trimester of pregnancy, with more than 45 percent in the intrapartum period (Lawn and others ; Lawn and others 2016). The majority of these stillbirths (98 percent) occur in LMICs (Lawn and others 2014).
Significant proportions of these maternal, fetal, and newborn deaths are preventable. A crucial focus of recent initiatives, such as Ending Preventable Maternal Mortality, is quality of care (WHO 2015b). This chapter discusses biomedical interventions for major causes of morbidity and mortality in pregnancy and childbirth in the context of people’s right to access good quality, respectful, and timely care—wherever they may live.
© 2016 International Bank for Reconstruction and Development / The World Bank.