Maternal and infant mortality are global health challenges that reflect a society’s well-being and development. These preventable deaths highlight systemic disparities in healthcare access and quality, underscoring the need for global action. Addressing these issues is a matter of public health and a reflection of societal commitment to human rights.
Understanding Maternal and Infant Mortality
Maternal mortality refers to the death of a woman while pregnant or within 42 days of the termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. The International Classification of Diseases, Tenth Revision (ICD-10) uses codes O00-O99 to categorize conditions related to pregnancy, childbirth, and the puerperium, which includes maternal deaths. These deaths are further classified as direct obstetric deaths, arising from complications of pregnancy, labor, or the puerperium, or indirect obstetric deaths, resulting from pre-existing diseases aggravated by pregnancy.
Infant mortality is defined as the death of a child before their first birthday. Within ICD-10, codes P00-P96 are used for certain conditions originating in the perinatal period, and R95 specifically designates Sudden Infant Death Syndrome (SIDS). This metric is typically expressed as the number of infant deaths per 1,000 live births.
Global trends reveal a decline in maternal mortality, with the maternal mortality ratio (MMR) decreasing by approximately 40% between 2000 and 2023, from 328 to 197 deaths per 100,000 live births. Despite this progress, over 700 women died daily in 2023 from preventable causes related to pregnancy and childbirth, with most of these deaths occurring in low- and lower-middle-income countries. Similarly, the global infant mortality rate has seen substantial reductions, falling from about 140 per 1,000 live births in 1950-1955 to 27.4 in 2020, and further to 27.10 in 2023. However, significant disparities persist between high-income and low-income countries, highlighting ongoing challenges in achieving equitable health outcomes for mothers and infants worldwide.
Key Contributing Factors
Maternal deaths often stem from direct obstetric complications, frequently exacerbated by systemic issues. Severe bleeding, particularly postpartum hemorrhage, is a leading direct cause globally, often occurring when the uterus fails to contract adequately after delivery.
Infections, such as sepsis, also pose a significant threat, especially in settings with poor hygiene, inadequate access to clean water, or a lack of sterile equipment during childbirth. Hypertensive disorders like pre-eclampsia and eclampsia, characterized by high blood pressure during pregnancy, can lead to severe complications including seizures and organ damage. Complications from unsafe abortions and obstructed labor also contribute to maternal mortality.
Indirect causes of maternal mortality include pre-existing medical conditions like heart disease, diabetes, HIV/AIDS, and malaria, which can be aggravated by pregnancy. Beyond medical factors, socioeconomic determinants play a substantial role. Poverty, limited education, and gender inequality can restrict women’s access to quality healthcare services, preventing them from seeking timely prenatal care or delivering in a health facility. Inadequate healthcare infrastructure, including insufficient numbers of trained health providers and shortages of essential medical supplies, further contribute to poor outcomes.
For infants, leading causes of mortality include prematurity and low birth weight, which make newborns more vulnerable to health complications. Congenital anomalies or birth defects are another significant factor. Sudden Infant Death Syndrome (SIDS), a sudden and unexplained death of an infant under one year of age, remains a concern. Birth complications like asphyxia (lack of oxygen) and birth trauma also contribute to infant deaths. Infections, such as pneumonia, diarrhea, and sepsis, are prevalent causes, particularly in regions with limited access to clean water and sanitation.
Underlying socioeconomic factors also influence infant mortality rates. Poverty, inadequate maternal education, and poor housing conditions can lead to malnutrition and increased susceptibility to illness in infants. These factors often interact, increasing the likelihood of complications for both mother and baby.
Strategies for Improvement
Reducing maternal mortality requires a comprehensive approach focused on enhancing access and quality of healthcare services. Universal access to quality antenatal care, including regular check-ups, nutritional guidance, and screening for potential complications, is an important preventative measure.
Ensuring skilled birth attendants, such as doctors, nurses, and midwives, are present during labor and delivery can significantly improve outcomes, as they possess the expertise to manage normal deliveries and identify complications. Access to comprehensive emergency obstetric and newborn care (EmONC) is also necessary to address major causes of maternal death, such as hemorrhage, sepsis, and obstructed labor.
Effective postpartum care, including family planning and mental health support, helps manage potential complications in the six weeks following delivery. Where legal, access to safe abortion services can also reduce maternal deaths from unsafe procedures. Strengthening health systems, including addressing poor quality of care, is also important.
For infant health, essential newborn care practices are foundational to survival. These include immediate drying of the newborn, promoting skin-to-skin contact, and initiating early and exclusive breastfeeding for the first six months of life, which provides optimal nutrition and protects against infections. Immunization programs are also effective in preventing common childhood illnesses. Improved access to clean water and sanitation significantly reduces the incidence of diarrheal diseases, a leading cause of infant mortality.
Community-based health interventions, alongside public health policies, contribute to better infant survival rates. Educating parents on safe sleep practices, such as placing infants on their backs to sleep and keeping their sleep area clear of soft objects, can reduce the risk of Sudden Infant Death Syndrome (SIDS). Addressing socioeconomic inequalities through broader initiatives like poverty reduction and improved housing conditions supports overall maternal and infant well-being. International collaborations and sustained investment are also necessary to accelerate progress in maternal and newborn health, especially in high-burden regions.