Safe childbirth needs more than medical services

Abstract

PIP: Obstetrician-gynecologists analyzed maternal mortality data from at least 1 rural area of Indonesia, the Philippines, and Thailand to determine nonmedical factors contributing to maternal deaths. They also gathered data from Brunei and Singapore but the data were insufficient (only 3 deaths in Brunei and 0 in Singapore). Overall the leading causes of death were in order eclampsia/intracranial hemorrhage, postpartum hemorrhage, and sepsis. 33% of decreased mothers were 20 or 35 years old. Most mothers had lived in rural areas where there were few health care facilities, inadequate transportation, and much delay between emergence of a problem and medical attention. Lack of education was a risk factor, e.g., 40% of Thai mothers had no education. Most women in the Philippines and Indonesia worked long hours and hauled heavy loads. There was a considerable link between primiparae and grand multiparae and maternal mortality. 90%, 68%, and 59% of maternal deaths in Thailand, the Philippines, and Indonesia, respectively, were of these parities. Almost 66% of the women had not used contraceptives. Overall 33% of the women lived near medical facilities. In Indonesia, this figure was as high as 62%. 40%, 13%, and 9% in Thailand, Indonesia, and the Philippines, respectively, had no access to transportation to take them to a facility. 21%, 46%, and 30% in Indonesia, the Philippines, and Thailand did not receive any prenatal care and 50% of mothers in Indonesia did not feel they needed prenatal care. Inappropriate delivery techniques also contributed to maternal deaths. 90% of deaths occurred after delivery. Considerable bleeding was a contributing factor in 62%, 55%, and 40% of maternal deaths in Indonesia, the Philippines, and Thailand, respectively. A blood transfusion would have saved many of them.