Maternal mortality, defined as the death of a woman during pregnancy or within 42 days of termination of pregnancy, remains a pressing public health challenge in Africa. While direct obstetric causes such as hemorrhage, infection, and obstructed labor have been widely recognized as major contributors to maternal deaths, there is growing concern over the increasing proportion of maternal deaths due to indirect causes. These indirect causes include pre-existing medical conditions and non-obstetric diseases that are aggravated by pregnancy, such as diabetes, anemia, hypertension, malaria, tuberculosis, and HIV/AIDS (World Health Organization, 2023).
This article explores the impact of indirect causes on maternal mortality in Africa, examines the challenges associated with their management, and highlights strategies for improving maternal health outcomes in the region.
Understanding Indirect Causes of Maternal Mortality
Indirect maternal deaths refer to deaths resulting from pre-existing conditions or diseases exacerbated by pregnancy. These conditions pose significant risks for pregnant women, often requiring specialized medical care that may not be readily available in many healthcare settings across Africa (Akinokun, 2021).
Key Indirect Causes of Maternal Mortality
- Diabetes:
- Pregnancy can worsen pre-existing diabetes or lead to gestational diabetes.
- This increases the risk of complications such as pre-eclampsia, preterm birth, and macrosomia (large birth weight), which may lead to difficult labor and delivery (World Health Organization, 2023).
- Anemia:
- Iron-deficiency anemia is prevalent among pregnant women in Africa, often due to poor nutrition and malaria.
- Severe anemia increases the risk of postpartum hemorrhage, infection, and mortality (UNICEF, 2023).
- Hypertension and Pre-eclampsia/Eclampsia (PE/E):
- Hypertensive disorders of pregnancy are a major cause of maternal deaths in Africa.
- Conditions such as pre-eclampsia and eclampsia can lead to severe organ failure, stroke, and death if not properly managed (World Health Organization, 2024).
- Malaria, Tuberculosis, and HIV/AIDS:
- Malaria in pregnancy significantly increases the risk of maternal anemia, stillbirth, and neonatal mortality.
- Tuberculosis and HIV/AIDS weaken the immune system, making pregnant women more vulnerable to infections and severe complications (iAHO, 2022).
Impact of Indirect Causes on Maternal Health Outcomes
1. Increased Risk of Pregnancy Complications
Women with pre-existing medical conditions are at higher risk of developing serious complications during pregnancy, childbirth, and the postpartum period. For example, women with diabetes have an increased risk of developing pre-eclampsia, birth complications, and neonatal distress (MSD for Mothers, 2024).
2. Challenges in Managing Indirect Causes
Indirect causes of maternal mortality require complex management strategies, including specialized medical interventions, regular monitoring, and access to life-saving medications. However, in many African countries, healthcare systems lack the necessary resources, trained personnel, and essential medications to adequately manage these conditions (Nnadi et al., 2022).
3. Burden on Healthcare Systems
The increasing number of women requiring specialized obstetric care due to indirect conditions overwhelms healthcare facilities, particularly in rural and under-resourced areas. The demand for medications such as magnesium sulfate (for pre-eclampsia), blood transfusions, and insulin (for diabetes management) often exceeds supply (Eghieye, 2014).
4. Contribution to High Maternal Mortality Ratios
- In 2020, the maternal mortality ratio (MMR) in Africa was estimated at 531 deaths per 100,000 live births—one of the highest in the world (World Health Organization, 2024).
- Indirect causes exacerbate this burden, making it difficult for countries to meet the global target of reducing MMR to less than 70 per 100,000 live births by 2030 (UNICEF, 2023).
Strategies to Address Indirect Causes of Maternal Mortality
1. Strengthening Referral Systems
- Efficient referral networks must be established to ensure that pregnant women with pre-existing conditions receive care at facilities equipped to manage their needs.
- Linking primary healthcare centers with specialized hospitals will facilitate timely access to emergency obstetric care (Akinokun, 2021).
2. Expanding Health Insurance Coverage
- High out-of-pocket healthcare costs prevent many pregnant women from seeking care.
- Expanding health insurance coverage can reduce financial barriers and enable more women to receive necessary treatments during pregnancy (MSD for Mothers, 2024).
3. Addressing Healthcare Worker Shortages
- Investing in the training and deployment of midwives, obstetricians, and community health workers is crucial.
- Task-shifting strategies, where trained nurses and midwives take on specific maternal health responsibilities, can help address workforce shortages (Eghieye, 2014).
4. Improving Health Infrastructure
- Equipping healthcare facilities with essential drugs, blood transfusion services, and medical equipment is critical for managing indirect causes of maternal mortality (World Health Organization, 2019).
5. Promoting Antenatal Care (ANC)
- Regular antenatal checkups can help detect and manage pre-existing conditions early.
- However, only 60.5% of pregnant women in Africa attend at least four ANC visits—with significant disparities between countries (Chad: 31.4%, Ghana: 91.8%) (UNICEF, 2023).
6. Community-Based Public Health Campaigns
- Raising awareness about indirect causes of maternal mortality, the importance of early detection, and healthcare-seeking behavior is essential.
- Engaging families, traditional birth attendants, and community leaders can promote timely care-seeking behaviors (World Health Organization, 2024).
7. Leveraging Digital Health Programs
- Mobile health (mHealth) programs can provide pregnant women with timely reminders for antenatal visits and educational messages about maternal health (iAHO, 2022).
Conclusion
Maternal mortality in Africa remains a significant public health challenge, with indirect causes playing an increasingly prominent role in maternal deaths. Addressing this growing concern requires a multifaceted approach, including improving referral systems, expanding healthcare coverage, strengthening health infrastructure, and investing in skilled birth attendants and emergency obstetric care.
By addressing both direct and indirect causes of maternal mortality, expanding access to skilled birth attendants, and ensuring quality emergency obstetric care, Africa can make significant strides toward achieving SDG 3.1 and reducing maternal deaths.
References
- Akinokun, R. T. (2021). Reducing maternal mortality in Sub-Saharan Africa through emergency obstetric care. European Journal of Midwifery, 5(September), 39.
- Eghieye, I. U. (2014). Maternal Mortality in Africa: Challenges and Strategies.
- MSD for Mothers. (2024). Maternal Health in Africa: Strategies for Improvement.
- Nnadi, C. I., et al. (2022). Trends in Maternal Health in Sub-Saharan Africa.
- UNICEF. (2023). Maternal Mortality and Skilled Birth Attendance in Africa.
- World Health Organization. (2023). Extended Report on SDG 3: Maternal Mortality.
