Maternal Mortality and Morbidity in Developing Countries: Factors and Strategies

This essay provides an overview of the statistics of maternal mortality and morbidity in developing countries and discusses the factors associated with it. It also suggests strategies to address these problems, such as increasing the level of literacy among expecting mothers, improving healthcare access and awareness, and reducing child marriage. The essay highlights the need for investments, interventions, and enabling policies to achieve the Millennium Development Goals.

Running head: ESSAY
Discuss the factors associated with maternal mortality and maternal morbidity in developing
countries. What strategies can you suggest to address these problems and why
Name of the Student
Name of the University
Author Note

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Introduction
Morbidity and mortality though inter-related, are two different terns. Mortality means
state of being subject to death and morbidity means a condition of being diseased. The
concept of maternal morbidity and mortality holds immense significance in the domain and
childbirth and health of the mother (Filippi et al. 2016). According to the World Health
Organisation in spite of having the high level of global focus over the maternal morbidity and
mortality as an alarming public health issue, very poor knowledge is available in the domains
of maternal mortality and morbidity along with the reasons underlying their occurrence
(Filippi et al. 2016). The following essay aims to provide a detailed understanding about the
maternal mortality and morbidity in the developing countries around the world. The essay
will initiate via providing an overview of the statistics of maternal mortality and morbidity in
developing countries followed at the analysis of the underlying reasons and strategies to
overcome this scenario.
Statistics of maternal mortality and morbidity
UNICEF India (2018) stated that maternal mortality and morbidity rate are high in the
Asia and Africa in comparison to the countries in the Northern Europe and America. In
relation to the maternal mortality and morbidity in Indian, one developing country in Asia,
UNICEF highlighted that the maternal mortality rate has decreased from 212 deaths per
100,000 live births during the year 2007 to 167 death in the year 2013. However, the overall
picture of maternal morbidity in India is still alarming. Under the global context UNICEF
highlight that around the world, 800 women die each day from modifiable causes associated
with pregnancy and childbirth and of these 20% accounts to Indian population. Annually it is
estimated that 44,000 women die due to modifiable risk factors in pregnancy in India.
Another Asian country which suffers from high rate of maternal mortality and morbidity is

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Afghanistan. According to the survey commissioned Afghan Ministry of Public Health and
conducted by US Centres for Disease Control and prevention and UNICEF, the maternal
mortality ratio of Afghanistan accounts to 1600 deaths per 100,000 live births and this
highest in the world. In the most remote and in rural districts on Afghanistan, the estimate
accounts for 6507 deaths per 100,000 live births. The most common cause of death includes
obstructed labour especially among the young women and lack of skilled birth attendant
(Britten 2017).
Figure: Maternal mortality ratio in India
Source: National Institution for Transforming India Government of India 2018

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Under African context, African Population and Health Research Centre [APHRC]
(2017) highlighted that in Nigeria, one out of 13 women die during labour pain or the at the
time of delivery or immediately post delivery tenure. The risk is high in comparison to other
parts of Africa where the ratio is 1 out of 31 child births. Nigeria accounts for about 40,000
maternal death per year which increase the overall rate of morbidity in the obstetric
department and accounts for about 14% of the global maternal mortality and morbidity toll.
According to APHRC (2017), Nigeria is the second largest contributor of maternal morbidity
after India. 109 Nigerian women die encounters premature death from preventable causes at
the time of pregnancy or during the time of delivery.
Figure: Trends in Maternal Mortality Rate per 100,000 live births from 1990 to 2015
(Source: APHRC 2017)
Reasons underlying maternal morbidity and mortality
Caldwell (1986) highlighted that the main reasons underlying the maternal mortality
and morbidity in the developing or poor countries are guided by the socio-economic factors,

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gaps in designing the healthcare systems, medical quotient, and reproductive factor. Other
associated cause of maternal mortality and morbidity in the developing countries are guided
by direct obstetric causes like hemorrhage, infection, ruptured uterus, hypertensive disorders,
anemia and hepatitis. Kane (1991) also highlighted that the maternal death related to sepsis
mostly encounters from the illegally induced abortion, early age pregnancy or multiple of
unplanned pregnancy.
Teenage Marriage
According to Mensch et al. (1993), high rate of maternal mortality in the developing
countries is due to high rates of childhood marriage. Raj and Boehmer 2013 conducted a
study in order to analyze the association between national rates of girl child marriage and
maternal mortality and morbidity in the developing countries around the world. Raj and
Boehmer 2013 mainly analyze 97 nations for which the girl marriage data was available. The
regression analysis adjusted for the development countries around the world highlighted that
there is significant association between the child marriage and high incidence of maternal
mortality and morbidity. In relation to this analysis, Fall et al. (2015) argued that the
psychological status of a teenage girl is underdevelopment to withstand the load of childbirth
and this leads to internal hemorrhage and increasing the tenacity of maternal mortality.
Unplanned childbirth
According to Royston and Sue Armstrong (1989), unplanned family planning or
conceiving within the gap of one year increases the chances of maternal mortality and thereby
increasing the overall morbidity. This tendency is more prone in the countries like
Afghanistan, Pakistan and Ethiopia. According to the study undertaken by Wado, Afework
and Hindin (2013), unintended pregnancies and lack of use of the proper maternal healthcare

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services is the main reason behind the high rate of maternal morbidity and mortality in
Ethiopia. Wado, Afework and Hindin (2013) mainly conducted a survey among 1370 women
with recent birth in a Health and Demographic Surveillance Site (HDSS) in southwestern
Ethiopia. The statistical analysis highlighted that women are of the opinion that majority of
the pregnancy are unintended and this increases the complications at the time of childbirth
and thereby increasing the rate of morbidity.
Unbooked admission in the hospital at the time of delivery
According to Guerrier et al. (2013), in spite of taking considerable efforts towards
reducing maternal mortality and morbidity ratio (MMR) during the tenure of 1990 to 2015
globally, a number of pregnant women still encounters death in the developing countries. It is
highlighted that the pregnancy related mortality is mainly due to delays in fetching proper
medical help or medical service on time or receiving the desired care on time at the time of
delivery or during the gestational period. Guerrier et al. (2013) mainly conducted a study in
order to determine incidence and caused of maternal mortality over a period of 8 months in
the rural and secondary health care facility situated in Jahun, in the northern fringe of
Nigeria. The mainly used the structure of the retrospective observational study over 41 bed in
the obstetric ward during October 2010 to May 2011. The analysis of the demographic data
and obstetric traits highlighted that the majority of the maternal and neonatal mortality
occurred due to unbooked admissions in the hospital ward due to high labour pain during the
time of delivery. Other reasons highlighted due to high incidence of maternal mortality and
morbidity includes obstructed labour, hemorrhagic shock and puerperal sepsis (Guerrier et
al., 2013).
Lack of proper healthcare access
Thaddeus and Maine (1994) highlighted that lack of proper healthcare access and lack
of trained professionals in the healthcare units in the remote areas of the developing countries

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are the reason underlying the increase rate of mortality and morbidity in the developing
countries. Birmeta, Dibaba and Woldeyohannes (2013) stated that rural regions of the
developing countries like Ethiopia is devoid of proper healthcare clinics and training
midwives to assist the women at the time of their delivery and thus increasing the morbidity
and mortality of the pregnant women.
Strategies to overcome the problem
Increasing the level of literacy among the mother
According to policy makers and the demographers, the formal schooling of the
mothers even at the level of primary school is associated with the lower risk of maternal
mortality and morbidity along with decreasing the risk of child mortality (Barro & Lee 2013).
However, Barro and Lee (2013) highlighted that how primary level of schooling among the
mothers of the developing countries is helpful in reducing the overall health of the maternal
mortality and morbidity is puzzling. In order to understand the effect the mother reading and
primary level education over the maternal mortality and morbidity, Smith-Greenaway (2013)
conducted demographic and health survey study under Nigerian perspective. Smith-
Greenaway (2013) mainly used the demographic data in order to analyse the women reading
skills and literacy level in relation to maternal morbidity and mortality. The analysis of the
results highlighted that is more demographic data analysis is required to be undertaken in
order to understand how mother’s reading skills lowers the level of maternal and child
mortality. However, the demographic analysis study conducted by Smith-Greenaway (2013)
highlighted increase in the level of primary school among the mothers of the developing
countries like Nigeria helps to increase the level of awareness among the expecting mother in
the domain of importance of basic hygiene and accessing the service of the healthcare

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organization at the time of delivery and this help to reduce the vulnerability of the maternal
mortality and morbidity.
Improving proper healthcare access and awareness
Montgomery et al. (2014) are of the opinion that one of the effective way of
preventing maternal mortality and morbidity in the developing countries is increase in the
overall healthcare access in the remote areas along with increase in the level of pregnancy
related awareness and concept of family planning. The study conducted by Moyer, Dako-
Gyeke and Adanu (2013) in Sub-Saharan region revealed that facility based delivery and
effective person-centred care plan for the mother at the time of pregnancy and at the time of
delivery is successful in reducing the level or maternal morbidity and mortality. The
government must also come forward towards increasing the overall awareness of pregnancy
and the normal hygiene, lifestyle and the nutritional plan that are required to be followed at
the time of pregnancy. The reports highlight that in the rural regions of the developing
countries like in India, Bangladesh and in parts of Pakistan and Afghanistan; the pregnant
women are forced to perform labour work and are deprived of nutritional diet. This increases
the maternal mortality and morbidity rate (Islam et al. 2015). It is the duty of the government
to come forward and take active initiative in designing awareness program under community
health approach in order to increase the knowledge of the mass about pregnancy and the
physiological needs of a woman body at the time of pregnancy. The World Health
Organisation is taking active initiatives to work in association with the NGOs and the
developing countries in order increase pregnancy related awareness (Montgomery et al.
2014).
Additional approaches
Other approaches that are required to be undertaken in order to decrease the maternal
mortality and morbidity in the developing countries throughout the world is reduction in the

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child marriage along with increase in the overall healthcare delivery services directed towards
the young adults mother. The reason behind this is adolescent mothers are more vulnerable in
developing complications during pregnancy and at the time of delivery and post delivery
process. UNICEF supports cross-sectors initiatives in order to improve the maternal health in
partnership with the organisations in the domain of nutrition and communication
development. The government of India, one of the developing countries where rate death tolls
of mother at the time of child birth are high is taking active initiatives towards reducing the
maternal morbidity and mortality. The Indian government has launches special campaign in
order to reduce the number of child marriages in the rural regions of India along with the
implementation of Janai Shishu Suraksha Karyakaran scheme which provides special
maternity care services to the expecting mothers in the rural areas of India (UNICEF India
2018).
Conclusion
Thus from the above discussion, it can be concluded that the overall rate of the
maternal mortality and morbidity is high in the developing countries. Under developing
countries which top the table of the maternal mortality and morbidity include Nigeria,
Afghanistan, India, Pakistan, Bangladesh and Ethiopia. Mainly the countries of Asia and
Africa score high in the level of maternal mortality and morbidity. The analysis of the
literature and the published governmental reports surfaced few reasons underlying high rates
of mortality and morbidity in the developing countries and these reasons include teenage
marriage, unplanned pregnancy, unbooked admission in the hospitals and lack of proper
healthcare access. The review of the literature highlighted few strategies that can be proved to
be effective in reducing the maternal mortality and morbidity rate. Effective strategies are
increasing the level of literacy among the expecting mother, increasing healthcare access in

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the remote areas and increase in the level of awareness. Moreover, the government of these
developing countries are also required to come forward and join hands with organisations like
WHO and UNICEF towards developing and implementing effective prevention strategies.
Recommendation
According to Kuruvilla et al. (2014), decreasing maternal mortality and morbidity rate
in the developing countries is the main priority in the Millennium Development Goals
(MDGs). Evidence suggests that investments and interventions and enabling policies and
important in order to implemented these goals in an effective manner. However, less is
known regarding why few developing countries obtain faster progress in comparison to other
developing countries towards reducing the maternal morbidity and mortality. Kuruvilla et al.
(2014) highlighted that the success factor for Women’s and Children health studies helped to
address this gap in knowledge via the use of statistical tools and econometric analysis of data
from 144 developing countries for over 20 years. This analysis highlighted that there is no
optimal framework for fast track recovery in some countries. The main goal for the fast track
recovery can mainly be done via the implementation of the tailored made strategies and the
tenacity of adapt the change by the target population. These tailored made strategies must be
designed through the critical analysis of social determinants of health of that particular
country. These tailored made strategies help through proper access of the social determinants
of health will help to reduce the maternal along with infant mortality and morbidity among
the developing countries in a robust manner. Moreover, accountability, decision-making
process and stakeholder analysis must also be implemented in order to achieve the significant
results on time (Kuruvilla et al. 2014).

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