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Approaches to reduction of maternal mortality in resource-limited settings

Haywood L Brown, MD
Maria J Small, MD, MPH
Section Editor
Susan M Ramin, MD
Deputy Editor
Kristen Eckler, MD, FACOG


In 2000, 189 nations pledged to free people from extreme poverty and multiple deprivations [1]. The specific target for maternal health was to reduce each country’s 1990 maternal mortality ratio (MMR) by three quarters by 2015 [2]. This goal was expanded by the United Nations Sustainable Development Goals to reduce the global MMR to less than 70 per 100,000 live births by 2030 [3].

This will require the involvement of health systems, communities, and families globally, and necessitate addressing political, economic, social, technical, and environmental factors contributing to maternal morbidity and mortality.

For pregnant women, optimizing intrapartum care appears to be the single most important intervention for reducing maternal mortality in both high-income countries (HIC)/resource-rich settings and middle/low-income countries (MIC/LIC)/resource-limited settings [4,5]. The leading causes of mortality in these women are hemorrhage, hypertensive disorders, infection, obstructed labor, and complications from unsafe abortions. In LICs, major causal factors are inadequate prenatal, intrapartum, and postpartum care by skilled birth attendants and inadequate facilities, equipment, and services. For nonpregnant women, family planning is the single most important intervention for reducing maternal mortality.

This topic will discuss approaches to reduction of maternal mortality in the poorest parts of the world. In these areas, dying as a result of pregnancy or childbirth is about 1 in 6 compared with about 1 in 30,000 in Northern Europe [6]. An overview of principles of maternal mortality, including strategies for reduction in high income countries, is reviewed separately. (See "Overview of maternal mortality and morbidity".)


One model suggested a stepwise approach that coupled improved family planning with incremental improvements in skilled attendance, transport, referral, facilities, and intrapartum care would prevent three of four maternal deaths [7]. These interventions are discussed below.


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Literature review current through: Sep 2016. | This topic last updated: Apr 22, 2016.
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