Rates of maternal deaths, stillbirths, and neonatal deaths in sub-Saharan Africa and south Asia continue to be high, according to a large new study—and the proportion of maternal and neonatal deaths that occur around the time of birth are even higher than published estimates, say the authors.
The study also found that stillbirths prior to birth are more common than those occurring during the birth process, and that 90% of all stillbirth deaths are linked with maternal health issues.
Co-authors of the study, published October 22, 2018 in Lancet Global Health, included two researchers from Harvard T.H. Chan School of Public Health’s Department of Global Health and Population—Emily Smith, research associate, and Wafaie Fawzi, Richard Saltonstall Professor of Population Sciences and chair of the department.
While estimates of maternal and neonatal mortality and stillbirths typically rely on models based largely on survey data, which is known to be of variable quality, the new study provides high-quality data about the extent, timing, and causes of all of these deaths in sub-Saharan Africa and south Asia. The researchers analyzed outcomes from nearly 270,000 pregnancies across the two regions.
Previous research suggested that stillbirth and neonatal mortality rates were roughly the same in the two regions studied, but the new research found that these rates were about two times higher in parts of south Asia than in sub-Saharan Africa.
The study also found that most pregnancy-related deaths, stillbirths, and neonatal deaths in both regions occurred during labor, delivery, and 24 hours after delivery.
Other findings of the study included:
- Obstetric hemorrhage, non-obstetric complications, hypertensive disorders of pregnancy, and pregnancy-related infections accounted for more than three-quarters of maternal deaths and stillbirths.
- The most common causes of neonatal deaths were perinatal asphyxia (when a baby has trouble breathing), severe neonatal infections, and complications of preterm birth.
- Maternal mortality ratios in sub-Saharan Africa were similar to those in south Asia—351 vs. 336 per 100,000 live births, respectively.
The authors recommended that health programs in sub-Saharan Africa and south Asia work to improve maternal and neonatal care in order to reduce the large numbers of pregnancy-related deaths. They said that stillbirths could be reduced by improving maternal care during the third trimester of pregnancies and during labor and birth. They also recommended a strong focus on interventions to reduce perinatal asphyxia, neonatal infection-related deaths, and preterm birth complications.
“I often hear that ‘we know what works’ in global health,” said Smith. “But I argue that we have alarmingly few tools in our toolbox related to reducing the risk of stillbirth, treating complications related to birth asphyxia, and preventing and treating neonatal infection. This new work highlights the importance of prioritizing discovery in these areas.”
Read the Lancet Global Health study: Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study