Analytical summary - Maternal and newborn health
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Most maternal deaths occur during or after childbirth, and most are preventable. The lifetime risk for maternal mortality in African women is 1 in 26, compared with 1 in 7300 in the developed world. Leading causes are bleeding (haemorrhage), hypertension, abortion-related problems and sepsis. Other risks are due to undernutrition, anaemia, tuberculosis, malaria and HIV/AIDS.
The WHO African Region is making little progress in reducing maternal mortality, although to achieve Millennium Development Goal 5 requiring a reduction in maternal mortality of three quarters by 2015, a decline of at least 5.5% a year is needed. The Region has the highest rate of newborn deaths in the world at 41:1000 live births.
Almost 60% of all adults living with HIV/AIDS in sub-Saharan Africa are women. A total of 1.4 million pregnant women are infected and 90% of children with HIV/AIDS become infected through mother-to-child transmission.
Factors influencing maternal and newborn mortality include weak health infrastructure, human resource shortages, lack of drugs and limited laboratory capacity.
Malaria poses a serious threat to pregnant women, as 90% of all malaria occurs in Africa. Malaria in pregnancy contributes to anaemia and low birth weight, as well as to other health conditions. Coinfection with HIV exacerbates malaria in pregnancy.
Other maternal and newborn risks include poor nutrition, especially in adolescent pregnancy. Perinatal mortality rates are twice as high when the mother is under the age of 20 years. The continuing low availability and uptake of contraceptives in all age groups compounds the problems, as 32% of maternal deaths could be prevented if women had unlimited access to contraceptives.
Antenatal care services are weak and inadequate, with only eight countries in the Region having an average of skilled birth attendance over 80%, the rate required to significantly reduce maternal mortality.
Political commitment has been made and policies are in place in a significant number of countries. However, implementation remains varied and inequitable and women continue to face geographical, financial, physical and health systems barriers to care.