MDG 5 has finally received greater attention. In addition to the original goal, which was to reduce maternal mortality by three quarters by 2015, a sub-goal – universal access to reproductive health – was added after a protracted power struggle. Maternal mortality is the indicator which best marks the intolerable difference between rich and poor countries, and it also says a lot about access to adequate health services (9, 10).
According to recent figures there were 359 000 maternal deaths in 2008, a decrease of 34 % from 1990 (9, 10). Altogether 99 % of these deaths continue to take place in the developing world. Sub-Saharan Africa and Southern Asia account for 87 %. The risk that a 15-year old woman will die as a result of pregnancy during her reproductive years is approximately 10 % in Afghanistan and over 3 % in sub-Saharan Africa. The minimal decline in maternal mortality in Africa can be attributed to the fact that fertility is high and that far too few have trained, qualified birth attendants to assist them during the birth. However, new figures indicate that maternal mortality would be considerably lower also in sub-Saharan Africa were it not for the aggressive HIV epidemics (9, 10).
The most usual causes of maternal mortality are illegal abortions, failure to progress in labour, bleeding, eclampsia and sepsis. Abortion is and remains controversial. But the proportion of deaths is declining because a greater number have access to medicamental abortion. Perhaps particularly unacceptable is the high proportion of pregnancies among very young girls in the majority of the world’s poorest countries. In India more than 40 % of females are married before the age of 18 – and 25 % before they are 16 (11). For females who are still in the process of growth and development, the risk of complications is five times higher than in women in their twenties. Another challenge, but also one which offers hope for future change, is the close link between maternal morbidity and perinatal mortality. Good obstetric help is still deficient and this would not only reduce maternal mortality but also the number of stillborn babies in addition to a decline in newborn morbidity and mortality (9, 10, 12).
An important health indicator that has not been included in the MDG list is the number of stillborn births. Every year there are over 2.7 stillborn births. Once again the poorest with the most inadequate health care are hit hardest. Women who suffer from illness during their pregnancy incur a greater risk of experiencing a stillbirth, and poor maternity care and birthing assistance increase the incidence (12) – (14).