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Maternal mortality is unacceptably high. About 830 women worldwide die every day from complications related to pregnancy or childbirth. In 2015, an estimated 303,000 women died during and after pregnancy and childbirth. Almost all of these deaths occur in low-income countries, and most are preventable.

In several countries in sub-Saharan Africa, maternal mortality rates have halved since 1990. Other regions, including Asia and North Africa, have made even greater progress. Between 1990-2015 The global maternal mortality rate (that is, the number of maternal deaths per 100,000 live births) fell by only 2.3% per year. However, since 2000, there has been a higher rate of accelerated decline in maternal mortality. In some countries, maternal mortality fell annually between 2000 and 2010. was above 5.5%, the level required to achieve the MDGs.

Sustainable Development Goals and the Global Strategy for Women's and Children's Health

Convinced that it is possible to accelerate this decline, countries are now united around a new goal - to further reduce maternal mortality. One of the targets of Sustainable Development Goal Three is to reduce the global maternal mortality rate to less than 70 per 100,000 births, with no country having a maternal mortality rate more than twice the global average.

Where do maternal deaths occur?

High maternal mortality rates in some parts of the world reflect inequities in access to health services and highlight the huge gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these cases occur in sub-Saharan Africa and almost one third in South Asia. More than half of maternal deaths occur in places with fragile conditions and humanitarian problems.

The maternal mortality rate in developing countries was 239 per 100,000 live births in 2015, compared with 12 per 100,000 in developed countries. There are significant differences in rates between countries. There are also large disparities within countries between high- and low-income women and between women living in rural and urban areas.

The highest risk of maternal death is among adolescent girls under 15 years of age. Complications during pregnancy and childbirth are the leading cause of death among adolescent girls in most developing countries. 2.3

Women in developing countries have, on average, many more pregnancies than women in developed countries, and face a higher risk of pregnancy-related death throughout their lifetime: a 15-year-old girl is about to die from a maternity-related cause. 1 in 4,900 in developed countries compared to 1 in 180 in developing countries. In countries designated as fragile states, the risk is 1 in 54; this is a testament to the consequences of collapsing health systems.

Why do women die?

Women die as a result of complications during and after pregnancy and childbirth. Most of these complications develop during pregnancy and are preventable. Other complications may exist before pregnancy but become worse during pregnancy, especially if they are not monitored. The main complications that lead to 75% of all maternal deaths are: 4

• heavy bleeding (mostly postpartum hemorrhage);
• infections (usually after childbirth);
• high blood pressure during pregnancy (preeclampsia and eclampsia);
• postpartum complications;
• unsafe abortion.

In other cases, diseases such as malaria and HIV/AIDS during pregnancy or related problems are the causes.

How can mothers' lives be saved?

Most maternal deaths are preventable because medical methods to prevent or manage complications are well established. All women need access to antenatal care during pregnancy, skilled care during labour, and care and support in the weeks after birth. Maternal health and newborn health are closely linked. An estimated 2.7 million newborn infants died in 2015 5 and an additional 2.6 million were stillborn 6 . It is especially important that all births are attended by trained health professionals, as timely care and treatment can make the difference between life and death for both mother and baby. It is especially important to ensure the presence of qualified health professionals during all births, since timely care and treatment can depend on life.

Heavy postpartum bleeding: a healthy woman can die within 2 hours if she does not receive medical attention. An injection of oxytocin given immediately after birth is effective in reducing the risk of bleeding.

Infection: After childbirth, infection can be ruled out by maintaining proper hygiene and identifying early signs and promptly treating it.

Preeclampsia: must be identified and managed appropriately before seizures (eclampsia) and other life-threatening complications occur. By administering medications such as magnesium sulfate, the risk of women developing eclampsia can be reduced.

To prevent maternal deaths, preventing unwanted and too early pregnancies is also vital. All women, including adolescent girls, need access to contraception, safe abortion services to the full extent permitted by law, and quality post-abortion care.

Why aren't mothers getting the help they need?

Poor women in remote areas are least likely to receive adequate health care. This is especially true in regions with low numbers of skilled health workers, such as sub-Saharan Africa and South Asia. Despite increased levels of antenatal care in many parts of the world over the past decade, only 51% of women in low-income countries receive skilled care during childbirth. This means that millions of births occur without a midwife, doctor or trained nurse.

In high-income countries, almost all women attend at least four antenatal clinics, receive care from a skilled health worker during childbirth, and receive postnatal care. In 2015, in low-income countries, only 40% of all pregnant women attended an antenatal clinic at least four times during the antenatal period.

Other factors that prevent women from seeking medical care during pregnancy and childbirth include the following:

• poverty;
• distance;
• lack of information;
• inadequate services;
• cultural characteristics.

To improve maternal health care, it is necessary to identify barriers to access to quality maternal health services and take action to eliminate them at all levels of the health system.

WHO activities

Improving maternal health is one of WHO's main priorities. WHO works to reduce maternal mortality by providing evidence-based clinical and programmatic guidance, setting global standards and providing technical support to Member States. In addition, WHO promotes more affordable and effective treatments, develops training materials and guidelines for health workers, and supports countries in implementing policies and programs and monitoring progress.

In addition, WHO promotes more affordable and effective treatments, develops training materials and guidelines for health workers, and supports countries in implementing policies and programs and monitoring progress.

During the 2015 United Nations General Assembly in New York, UN Secretary-General Ban Ki-moon launched the Global Strategy on Women's, Children's and Adolescents' Health 2016–2030. 7 This strategy is a roadmap for the post-2015 agenda, as described in the Sustainable Development Goals, and aims to end all preventable deaths of women, children and adolescents, and to create an environment in which these groups not only survive , but also successfully develop and see changes in the environment, health and well-being.

According to the WHO definition, maternal mortality is the death of a woman caused by pregnancy (regardless of its duration and location) and occurring during pregnancy or within 42 days after its end from any cause related to pregnancy, aggravated by it or its management, but not from an accident or a random cause.

This indicator allows us to evaluate all losses of pregnant women (from abortion, ectopic pregnancy, from obstetric and extragenital pathology during the entire gestation period), as well as women in labor and postpartum within 42 days after the end of pregnancy. The concept of “maternal mortality” does not include deaths resulting from murder, suicide, poisoning, injury and other violent causes.

Maternal mortality rate:

number of deaths of pregnant women (from the beginning of pregnancy), women in labor, women giving birth within 42 days after termination of pregnancy? 100,000 / number of live births.

The maternal mortality rate should be calculated at the level of district, city, region, region, and republic. In the institution where the death occurred, a detailed analysis of each case (without calculating the indicator) of death should be carried out from the perspective of its preventability.

When assessing the dynamics of maternal mortality in areas with low birth rates, in order to avoid errors, statistical methods should be used,

in particular, the alignment of the dynamic series using the moving average method, which allows you to replace each level of the series with the average value from this level and two adjacent ones, eliminate the influence of random fluctuations on the level of the dynamic series and helps to identify the main trend.

Analysis of the structure of the causes of maternal mortality allows us to establish the place of one or another cause among all deceased women.

Structure of causes of maternal mortality:

number of women who died from this cause? 1000 / total number of women who died from all causes.

Of essential importance in the analysis of maternal mortality is the calculation of the frequency of death from individual causes.

Maternal mortality from selected causes:

number of women who died from this cause? 100 / number of live births.

In the structure of causes of maternal mortality, the majority (80%) are obstetric causes, and approximately 20% are caused by causes related to pregnancy and childbirth only indirectly (in particular, extragenital diseases).

Among obstetric causes, 70% are complications of pregnancy and childbirth, 25% are consequences of abortion, and 5% are ectopic pregnancies. Among extragenital diseases, diseases of the cardiovascular system predominate.

The country's high maternal mortality rate is due to a number of reasons. In recent years, there has been an increasing deterioration in the health indicators of pregnant women, the rate of early coverage of their medical supervision, the quality of medical examination of pregnant women are decreasing, and there is a high prevalence of abortions.