Time to respond

Overview

Trying to understand why a mother died during pregnancy or childbirth, or even weeks later, can be incredibly frustrating. The medical causes may be known, but the full explanation for death from a treatable condition such as eclampsia remains unclear. Care may have been available in the woman’s community or in a nearby health facility, but still she died.

This report on maternal death surveillance and response (MDSR) quotes harrowing examples of death from preventable maternal causes such as the story of Assetou, who died while being taken to hospital on the back of a motorcycle. Or of Dhani, who died before her family could call an ambulance to their isolated village at night. The physical suffering of these women and the panic and misery felt by them and their families are almost impossible to imagine. We know of these cases because they were investigated and written up by experts from the Dead Women Talking initiative, trained to consider all contributing factors. But hundreds of other preventable maternal deaths occur every day about which we know little or nothing.

Many go completely unrecorded in countries that have weak systems for notifying vital events, or are misclassified under causes unrelated to motherhood. Maternal death reviews all too often focus solely on medical causes to the exclusion of other factors that may have contributed to a woman’s death, such as lack of transport or money to pay for care. These errors and omissions have resulted in a huge gap in our understanding of the magnitude and causes of global maternal mortality. Official reports underestimate the true magnitude by up to 30% worldwide and by 70% in some countries. This matters, because it is only by gathering and analysing large volumes of quality data that we can identify trends in maternal mortality – including the causes of deaths and where they occur – and use the knowledge to target health programmes and interventions that save women’s lives. That is why comprehensive and effective country MDSR systems are vital.