Maternal Mortality

Essay written by Dorothy Bauman, CPM, March of 2025

The rates at which women are dying daily around the world from pregnancy and childbirth related complications are undeniably shocking. In places like Uganda and East Africa, sixteen women are dying everyday from complications associated with pregnancy such as postpartum hemorrhage and sepsis, both being conditions that are very preventable, costing less than a few US dollars.

The Three Deadly Delays

There are three delays that cost the lives of so many of these mothers. The first delay is a delay in recognition of a problem. When women, men, and traditional birth attendants or community health workers are not educated about life-threatening complications, how to recognize them, and when to respond with treatment, how to prevent them, or how to treat them, they fail to take the needed steps in time for appropriate care. By the time it is recognized that more intervention is needed, it is often too late by then to reverse the deadly condition.

An example of this may include the water breaking days before labor. It may not be recognized that this is an open door for infection, and unless the woman takes special care to prevent infection and is prepared with how to recognize an infection and respond with appropriate treatment, this may lead to the death of both the baby and the mother.

Another example may be an obstructed labor. In this case, it may be a young mom of only fifteen years of age, who is laboring for days, but her pelvis is too immature for the baby to fit through. What ends up happening is that the baby's head gets stuck in the birth canal, and cannot proceed in birth. In many of those cultures, the woman may be looked at as being a failure to give birth well, and thus be put out into the animal barn to labor. After a while, the baby dies and begins to decay. This in turn causes the walls of the vagina to wear out and open up, leading to either urine leakage or bowel leakage. In time the baby slithers out, but the woman is damaged for life, and rejected by both her husband and community. This is called a fistula. Many women suffer from this all their life, and are often forced out into the fields to work since the odor coming from their body is nearly intolerable. There is a way to repair these fistulas and restore normal function, but many women may not know about the surgery or have the means to reach the hospital or pay for surgery.

These are only a few examples of what may kill or ruin women's lives.

The second delay is considered to be in transportation to a healthcare facility. Most women in these developing countries do not have their own vehicle but must pay someone to drive them, or pay the bus, taxi or train. This process is often a very long and drawn-out process, and may mean that they have to go begging or walking all day to find a driver. Then the vehicle might not be available till later in the day or even the next day. Then there are bad roads, bridges out, road blocks, traffic jam, or lack of fuel or money to pay. It may take hours of driving to only go a short distance.

The third delay is the delay of care once a health facility is reached. The woman who is bleeding her life out after giving birth may have to wait in line for help. Her partner, mother or friend may be sent off to go buy the medicines and supplies for a surgery, and may even have to first borrow money for the purchases. It may take hours to find a blood donor with the mother's same blood type who is willing to give. The hospital is likely way understaffed and overcrowded. The hospital may not even have the necessary supplies to give proper care, or may not be able to do surgeries that are life-saving. It may take time to call in the anesthesiologist for the surgery.

All these examples just give a small peak into the reasons why so many women in East Africa and parts of Asia are dying daily of childbirth related complications. Around the world, every single day two jumbo jets-worth of pregnant women are "crashing". 99 percent of these deaths are occurring in the underdeveloped countries. This is unacceptable and is primarily preventable.

The Problem

We also see how that where there is poverty, there is lack of education and lack of law and order and many other factors that strongly affect the rates of maternal mortality. A lot of deaths happen because of people's belief system.

For an example in Uganda, polygamy is not illegal. This creates a lot of problems. The first wife then is the primary one that is in charge of the house and the children even though she herself may not bear children. This creates extreme jealousy. The father then is also not involved like he should be and may be off in the city for weeks at a time. He does not get involved with women's issues, but is rather very self-centered, looking for his own advantages and not taking proper care of his wife and children. Women are expected to bear lots of children and to bear them early and well. Many of the wives are married off as adolescents of anything from 12 years to 16 years of age. These young girls are not fully grown themselves, and often times this causes many more problems such as obstructed labors leading to fistulas or even death.

When a woman goes into labor, it is often the mother-in-law that is the one expected to look after her. She may go to a traditional birth attendant (TBA) if she has enough money, but the TBAs are often not educated or trained themselves to deal with life-threatening complications. The laboring mother is expected to bring all her own supplies for the birth and cleaning herself up afterward, but may not have the money to buy such needed supplies. Often it happens that if a complication arises, they may not have recognized it in time, and by the time they do, it is often too late when they do end up reaching advanced care. If the mother survives, she may have developed a fistula, and will now be rejected by her husband and community as if she was a leper.

Where Is the Solution?

First off, before we can begin to fix this massive dilemma, the world must recognize that we have a problem! Leaders need to recognize the problem, legislators, police men, judges, lawyers, business men, fathers, journalists, news reporters, professors, and teachers. Young people need to be educated about this problem from childhood, and especially in high school and college when they are thinking about marriage or sexuality. Just as the quote goes:

"One form of heroism, the most common, and yet the least remembered of all – namely, the heroism of the average mother!" -C.K.

Much too often, motherhood is considered the lowest of occupations, and is despised by the more educated, rich or powerful folk. Yet they forget the very reality that if they had not had a mother to bear them and bring them into this world in good health, they would not exist. This is manifested in Ivan Godfrey Tibenkana's first response to the question, after hearing about how his country's maternal mortality rate was an equivalent of a minibus filled with pregnant women crashing and dying every single day, "Ivan, how many mothers would you wish should die?", and his response was, "Five". Ivan thought that with the new knowledge he had just gained, he'd help bring some practicality to the situation and bring the high number of sixteen, down to only a few – five. But when pressed with the question, "would you still say 'Five' if one of them were your mother?", reality hit home and he had to come to grips with himself… "No." "What about if one was your daughter, or your sister?" "No! No mother should die!" If the world could grasp this truth, we would see a whole lot less of maternal mortality, even in the poorest of countries. It does not take but a few dollars to buy drugs to stop hemorrhage.

Most problems can be prevented, but this happens after one is educated. Illiteracy and ignorance lead to neglect, laziness, lack of concern, and harmful choices. No, not just lack of education, but a lack of understanding. This understanding must come from a heart of concern, and eyes that are opened to the needs. It is originally God-ordained, and without God, society is destroying itself because all good things come from God.

As the scriptures say, "But whoso hearkeneth unto me shall dwell safely, and shall be quiet from fear of evil." (Proverbs 1:33), and again, "The fear of the LORD tendeth to life: and he that hath it shall abide satisfied; he shall not be visited with evil." (Proverbs 19:23), and yet again, "Thine own wickedness shall correct thee, and thy backslidings shall reprove thee: know therefore and see that it is an evil thing and bitter, that thou hast forsaken the LORD thy God, and that my fear is not in thee, saith the Lord GOD of hosts." (Jeremiah 2:19).

What Can I Do?

Ways to get involved and to help to make a difference may include many options. If we can understand the dilemma, then we can begin to formulate a plan.

There is no one single solution to the problem of mothers and babies dying by the loads every single day. Going into an area where 1 out of every 16 birthing women will die, bringing them supplies, setting up a clinic and saving the lives of these women and their babies myself as a trained professional midwife will not fix the problem. What will happen when I have to leave? When I can no longer care for them? When money and resources run out? This compares to the effectiveness of adding one drop of water to the ocean… it simply is not sustainable, and can only save a few of the millions dying daily. Besides, how will I communicate if I cannot effectively speak their mother tongue, and how will I gain the trust of those who believe that their dangerous cultural practices are the only way to give birth, and why should they trust a stranger who has a different idea about birth then they do?

They must first understand their responsibilities as fathers and mothers. Children must be provided for. Money must be made and set aside to pay for medical care over the time of the pregnancy and birth. Fathers who are the decision makers must be aware of the needs of their wife, and see to it that she is nourished and the children are nourished. If they can see what their wife goes through to have a baby, this helps them to understand the need. They then need to tell all their fellow-men about the need to also be responsible for their families, to provide and protect against harmful things. The men who are influential in society have the biggest advantage to teach other men about taking care of their wives during pregnancy and childbirth. Parents need to teach their children, especially before marriage, so that the children can make wise decisions for themselves.

Mothers and mothers-in-law of young mothers must support their pregnant daughters and help them recognize complications, and get care when needed. Transportation services must be put into place to be available at any time around the clock for an emergency. Healthcare providers need to build relationships with the communities and TBAs and help to educate them and supply for them. But for this to happen, the government must also recognize the need and put laws in place to protect mothers and babies lives, providing education, financial support, high-level hospital systems, mother-baby friendly initiatives, emergent transportation, and supplies. More focus must go to our mothers, who are giving their lives for humanity, and less focus to the environment, and other money-soakers like war. We must work together to achieve safe motherhood.

Otherwise, we are destroying ourselves.

Ref. Save The Mothers, The Game Changers, Where Have All The Mothers Gone?, Safe Motherhood Initiative, End Fistula, Baby Friendly Hospital Initiative, World Health Organization, UNICEF, United Nations Foundation.