Family health is one of the major aspects that may affect families all around the world, its effects may vary according to the socioeconomic situation, culture, health care systems, law, area of living, and other elements. Family health is a very diverse and important topic, it is receiving an increasing attention worldwide, because of the wide range of fields it contains and since families are built from members as father, mother, boys, girls, gender aspect is also present concerning health. Family health contains psychology, medicine, cognitive development, women’s health, children’s health, adolescent’s health mens health, nutrition, social issues and many more. Each one of the mentioned subjects has its own specialities ,characteristics, and effects on the family member who is facing a specific situation and further effects on the other family members.
Women’s health is one of these important subjects that has been examined,investigated and searched for decades, such as fertility, pregnancy, breast cancer and others. One topic that has been examined for years and still needs more research, studies, prevention and treatment is maternal mortality. World Health Organisation defines maternal mortality or maternal death as:
Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
This subject has influence and effects on the whole family structure, beside the pregnant women, it also affects babies, children, spouses socially, psychologically, mentaly, economically reaching to the cultural structure, raising challenges, difficulties and vast changes that need to be dealt with. Maternal mortality is always present when family health topic is raised. When a pregnant mother faces difficulties during her pregnancy, which leads to death leaving a newborn behind her, she leaves an important question behind her as well, why does this occur ? how can science, research, and medicine prevent this ? What is it connected with ? are there any solution ? how does this affect the general topic of family health? How this loss will affect the baby left behind ? How does it affect the rest of the family ? Is it connected to genes ? is it connected to medical treatment during pregnancy ? Is it connected to this mothers age and living circumstances ? Is it connected to culture ? What kind of preventive and treatment procedures are used ? Will the numbers and statistics connected to it decrease one day ? What are the Sustainable development goals related to it ? how can they be achieved and when? Are countries dealing with this as an urgent issue ? and giving it the attention it should have? All these questions and much more are left behind to think of and find answers.
Maternal mortality definition, reasons and rates distribution:
Maternal mortality definition is not only the regular definition mentioned above it also has further categories and complementary explanation concerning further cases derived from the pregnancy process, such as A late maternal death which is defined according to the ICD 10 as the death of a woman from direct or indirect causes more than 42 days, but less than one year after termination of pregnancy, and Maternal Near Miss (MNM) which is defined by WHO as a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy. Looking at the maternal mortality different definitions and categories by the World Health Organisation and the International Statistical Classification of Disease (ICD 10), and many other organisations that investigate the topic , and understanding further definitions and specifications lead to investigating the factors and reasons that lead to these deaths worldwide .
Moving to maternal mortality causes, there are many direct and indirect causes that lead to maternal mortality with its different categories. The majority of the deaths dont have a fully defined cause, its mostly a combination of direct and indirect causes that differ from a woman to another. Approximately three quarters of the deaths are related to direct obstetric causes, and one quarter is related to indirect causes. The most popular causes of maternal deaths are: Hemorrhage, postpartum hemorrhage and anemia, Hypertension and unblanced blood pressure, infections and sepsis,abortion related causes and unsafe abortions, depression after delivery. Urine incontinence and other related cause., HIV/AIDS as well as further different pregnancy and delivery complications and specific individual health status and risk factors.
Information , data and numbers concerning maternal mortality are derived from the hospital’s records, and reported cases in medical centers about people who seek medical care and treatment , as well as community records derived from studies, surveys, and collected data by the community members which is considered as a poor and limited source of information, because it relies on individual cases reporting which is not considered as a reliable source for documentation and research, in addition to the fact that this kind of limited range studies dont reflect the existing real situation. According to all this, the information related to maternal mortality is not sufficient or enough to have a full image about this topic, this lack of data makes it hard to understand what takes place in real life, especially in abandoned far areas with poor and limited medical care access and facilities, as well as the wide range of the unreported and unsafe home- deliveries and abortions and complications. As well as the lack of data concerning these womens diagnosis, background and medical history.
MMR – Maternal mortality ratio ( number of maternal deaths per 100,000 live births) is considered to be a high mortality rate, with 295,000 deaths during the year 2017, 66.5% occur in Sub-Saharan Africa countries. However, this rate has declined by 38% around the world, between the years 2000 and 2017, according to WHO report 2019. As all maternal mortality evidence, data and prevalence lead to the importance of this issue, it was mentioned as one of the eight goals mentioned by the Millennium Development Goals (MDGs) signed by UN countries in September 2000, to be achieved by the year 2015. Afterwards, maternal mortality was also mentioned one of the first topics in the Sustainable development goals (SDGs) signed by the United Nations in September 2015, these SDGs are expected to be achieved by the year 2030. In relation to maternal mortality the goal is to reduce maternal mortality ratio to less than 70 per 100,000 live births.
Low income countries have higher percentages of maternal mortality if compared with higher income and developed countries where the maternal mortality rate is 12 per 100,000 live births. Sub- Saharan african countries are known for having the highest maternal mortality rate all around the world with 546 maternal deaths per 100,000 live births, such as: Nigeria, Democratic Republic of congo, Ethiopia, Uganda,Tanzania and Kenya and more.
Many reasons in Africa and its sub-saharan countries lead to the occurrence of this high percentage of maternal mortality rates starting with the geographical factor,distribution of these countries villages and abandoned areas and the poor access to medical centers, because of long drives and distances, which is also connected to the lack of fast transportation, vehicles,and ambulances Moving to the lack of medical and health care centers especially in abandoned and far areas, this factor is very important in saving lives and making urgent intervention when needed, thousands of hundreds of african sub-saharan population dont get the needed and essential medical treatment, which makes it hard to survive urgent and acute cases, this makes it hard to seek medical care for women facing danger during pregnancy and delivery, as well as the lack of medical reporting and diagnosis. Its also very important to mention the young age and under age mariages that take place in sub-saharan areas which may be a risk factor for maternal mortality high prevalence as well as rape cases that may cause this. The incidences of diseases and outbreaks also play a role in maternal mortality high rates, uncontrolled transmitted diseases HIV/AIDs for example is considered one of the major risk factors for maternal mortality. Hygiene, sanitary products and access to clean water are also very important, lack of these elements cause infections, spread diseases and even may lead to exceeding the cases and causing more severe complications. Moving to culture, beliefs and traditions, in many sub-saharan areas in Africa, morals, tradition and inherited manners can lead to exceeding maternal mortality incidence, various beliefs and ways of dealing with women in general and young pregnant women especially. Women’s level of awareness and understanding of their health status, way of living, their circumstances, background and hereditary is vital, and can cause deterioration in their health status during pregnancy, and during the delivery process.
These mentioned numbers, rates, and causes, led to raising maternal mortality issue worldwide, and made it one of the most important issues to be listed among the MDGs and afterwards on the SDGs.