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Background: The process of audit standardizes protocols in departments and has long-term benefits. Maternal autopsies though routinely performed, deserve a special attention. Aims: This study was carried out to calculate the maternal mortality ratio (MMR) in a tertiary care hospital and to correlate final cause of death with the clinical diagnosis. An audit of maternal autopsies was carried out to evaluate current practices, identify fallacies and suggest corrective measures to rectify them. Materials and Methods: Eighty-nine autopsies of maternal deaths in the period 2003 to 2007 were studied in detail along with the clinical details. Results: There were 158 maternal deaths and 13940 live births in this five-year period. Maternal mortality rate was found to be very high (1133/ 100000 live births) in our institution with a high number of complicated referral cases (68/89 cases, 76%). Of the 89 autopsies, acute fulminant viral hepatitis was the commonest cause of indirect maternal deaths (37 cases, 41.5%). This was followed by direct causes like pregnancy-induced hypertension (12 cases, 13.4%) and puerperal sepsis (10 cases, 11.2%). Certain fallacies were noted during the audit process. Conclusion: During the audit it was realized that in maternal mortality autopsies, special emphasis should be given to clinicopathologic correlation, microbiological studies, identification of thromboembolic phenomenon and adequate sectioning of relevant organs. We found difficulty in identification of placental bed in the uterus in postpartum autopsies. A systematic approach can help us for better understanding of the pathophysiology of diseases occurring in pregnancy.

Indonesia has made improving the access to health workers, especially in rural areas, and improving the quality of health provider's key priority areas of its next five-year development plan. Significant steps and policy changes were taken to improve the distribution of the health workforce, in particular the contracted doctors program and later the contracted midwives program, but few studies have been undertaken to measure the actual impact of these policies and programs. This book is part of the inputs prepared at the request of the government of Indonesia's national development agency, Bappenas, to inform the development of the next national development plan 2010-14. Other inputs include reports on health financing, fiscal space for health, health public expenditure review, and assessments of maternal health and pharmaceuticals. Study findings highlight the importance not only of improving the supply of health care, but also of improving quality, so as to improve health outcomes. Over the period studied, important gains in the determinants of health outcomes have occurred in Indonesia. At the same time, however, the study shows that Indonesia, despite the significant gains, continues to suffer from serious challenges in the number and distribution, and in particular the quality, of its health workers.

Background: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa’s leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. Methods: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children’s Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of −3.0% (95% CI −2.9; −3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations’ sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. Conclusions: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations’ target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.

Since the early 1990s, countries in the Middle East and North Africa (MENA) Region have made admirable progress in reducing the gap between girls and boys in areas such as access to education and health care. Indeed, almost all young girls in the Region attend school, and more women than men are enrolled in university. Over the past two decades, maternal mortality declined 60 percent, the largest decrease in the world. Women in MENA are more educated than ever before. It is not only in the protest squares that have seen women whose aspirations are changing rapidly but increasingly unmet. The worldwide average for the participation of women in the workforce is approximately 50 percent. In MENA, their participation is half that at 25 percent. Facing popular pressure to be more open and inclusive, some governments in the region are considering and implementing electoral and constitutional reforms to deepen democracy. These reforms present an opportunity to enhance economic, social, and political inclusion for all, including women, who make up half the population. However, the outlook remains uncertain. Finally, there are limited private sector and entrepreneurial prospects not only for jobs but also for those women who aspire to create and run a business. These constraints present multiple challenges for reform. Each country in MENA will, of course, confront these constraints in different contexts. However, inherent in many of these challenges are rich opportunities as reforms unleash new economic actors. For the private sector, the challenge is to create more jobs for young women and men. The World Bank has been pursuing an exciting pilot program in Jordan to assist young women graduates in preparing to face the work environment.

Background This article examines the association between population density, maternal mortality, and under-5 mortality in countries throughout the world, as well as the mediating impacts of the Universal Health Coverage Service Coverage Index (UHC-SCI). Methods The World Health Organization’s website provided data on maternal mortality and the Universal Health Coverage Service Coverage Index for the years 2000–2020. The World Bank database included information on population density and under-5 mortality rates for nations between 2000 and 2020. Panel regressions were used to examine the association between population density and maternal and under-5 mortality in each nation, as well as the mediating influence of the Universal Health Coverage Service Coverage Index, while accounting for economic, environmental, and medical factors. Finally, data is divided into regressions based on World Bank member countries’ income levels to examine heterogeneity. Results The study included 175 countries and found a significant negative correlation between population density, maternal mortality, and under-5 mortality ( B = -1.015, -1.146, P  < 0.05). The Universal Health Coverage Service Coverage Index mediated this relationship ( B = -1.044, -1.141, P  < 0.05). Conclusions Increasing population density in countries around the world has helped to reduce maternal and child mortality. As population density has increased, so has the level of the Universal Health Coverage Service Coverage Index, which has proven effective in lowering maternal and under-5 mortality. Governments should plan interventions to build basic health facilities and allocate resources to health services based on population density, level of economic development, and the current state of their health systems, with the goal of stabilizing the rate of change in maternal and under-5 mortality and, eventually, achieving the Sustainable Development Goals.

BackgroundMaternal mortality in Ghana remains high at 263 deaths per 100,000 live births, with the Volta Region showing particularly concerning figures; 37.2% of women give birth without a skilled provider. Many rely on Traditional Birth Attendants (TBAs), whose role remains unofficial and unregulated. Causes of maternal death include hemorrhage, sepsis, hypertensive disorders, and unsafe abortions, compounded by limited access to emergency care and mistrust in clinical settings. To create a dialogue between the stakeholders to reduce maternal mortality, we want to screen the documentary Among Us Women. The documentary is set in rural Ethiopia, explores the choice between home and hospital birth. A first screening in Ghana revealed similar challenges—highlighting women's trust in TBAs and dissatisfaction with clinical care. The film successfully opened dialogue between midwives and TBAs, showing potential for collaboration.HypothesisWe propose that film screenings followed by inclusive dialogue will improve mutual respect and cooperation between TBAs and clinical staff in rural areas, leading to earlier interventions and reduced maternal deaths within one year.MethodA shortened, Ewe-dubbed version of the film will be shown in 60 randomly selected communities in the Volta Region, reaching 500+ stakeholders. Roundtables will follow each screening, supported by trained facilitators. Discussions and follow-up evaluations will inform a “community needs catalog” and provide data for potential national scale-up.DiscussionThe main question is if setting up an efficient dialogue as a result of a film screening in other communities is replicable. To set up a reliable study, test screenings of the film upfront will refine the approach, addressing language, group size, and ethical concerns. Using relatable storytelling and dialogue, the project fosters empathy, shared responsibility, and cultural sensitivity; laying the groundwork for long-term improvements in maternal health.

Introduction The unmet global burden of surgical disease is substantial. Currently, two billion people do not have access to emergency and essential surgical care. This results in unnecessary deaths from injury, infection, complications of pregnancy, and abdominal emergencies. Inadequately treated surgical disease results in disability, and many children suffer deformity without corrective surgery. Methods A consensus meeting was held between representatives of Surgical and Anaesthetic Colleges and Societies to obtain agreement about which indicators were the most appropriate and credible. The literature and state of national reporting of perioperative mortality rates was reviewed by the authors. Results There is a need for a credible national and/or regional indicator that is relevant to emergency and essential surgical care. We recommend introducing the perioperative mortality rate (POMR) as an indicator of access to and safety of surgery and anaesthesia. POMR should be measured at two time periods: death on the day of surgery and death before discharge from hospital or within 30 days of the procedure, whichever is sooner. The rate should be expressed as the number of deaths (numerator) over the number of procedures (denominator). The option of before-discharge or 30 days is practical for those low- to middle-income countries where postdischarge follow-up is likely to be incomplete, but it allows those that currently can report 30-day mortality rates to continue to do so. Clinical interpretation of POMR at a hospital or health service level will be facilitated by risk stratification using age, urgency (elective and emergency), procedure/procedure group, and the American Society of Anesthesiologists grade. Conclusions POMR should be reported as a health indicator by all countries and regions of the world. POMR reporting is feasible, credible, achieves a consensus of acceptance for reporting at national level. Hospital and Service level POMR requires interpretation using simple measures of risk adjustment such as urgency, age, the condition being treated or the procedure being performed and ASA status.

ObjectivesThe causes for persistently high and increasing maternal mortality rates in the United States have been elusive.MethodsWe use the shift in the ideological direction of the Republican and the Democratic parties in the 1960s, to test the hypothesis that fluctuations in overall and race-specific maternal mortality rates (MMR) follow the power shifts between the parties before and after the Political Realignment (PR) of the 1960s.ResultsUsing time-series data analysis methods, we find that, net of trend, overall and race-specific MMRs were higher under Democratic administrations than Republican ones before the PR (1915–1965)—i.e., when the Democratic Party was a protector of the Jim Crow system. This pattern, however, changed after the PR (1966–2007), with Republican administrations underperforming Democratic ones—i.e., during the period when the Republican Party shifted toward a more economically and socially conservative agenda. The pre-post PR partisan shifts in MMRs were larger for Black (9.5%, p<.01) relative to White mothers (7.4%, p<.05) during the study period.Conclusions for PracticeThese findings imply that parties and the ideological direction of their agendas substantively affect the social determinants of maternal health and produce politized health outcomes.SignificanceWhat Is Already Known on This Subject? The causes for persistently high and increasing maternal mortality rates in the United States have been elusive.What This Study Adds? We find that, net of trend, MMRs are higher under the most racially-conservative party of the period: The Democratic Party before the Political Realignment, the Republican Party after. Institutionalized racism—in the form of racialized federal-level policy—has detrimentally affected the health of all in the past century. Our findings bear important implications for political science, medical sociology, public health, and policy: A deep understanding of political processes is necessary for promoting health equity.

Female literacy plays a critical role on the overall growth and development of society. It has been proved from research that children who are taken care of by literate mothers get all round development in every aspect of their life. This paper analysed the impact of female literacy rate on the infant mortality and maternal mortality rate in different districts of Kashmir valley. For this linear regression method was used which shows the impact of female literacy rate on infant mortality rate and maternal mortality rate. From the result it has been observed that there is inverse relationship between female literacy rate and infant mortality and maternal mortality rate in districts of Kashmir valley. This study analysed that female literacy has immense contribution in declining the infant mortality rate and maternal mortality rate and thus help in improving the health status of both women and child.

The relevance of women in contributing to inclusive growth and consequently economic development in Nigeria cannot be overemphasized. Women play important social, economic and productive roles in any economy. Maternal mortality rate refers to the annual number of deaths of women from pregnancy-related causes per 100,000 live births, and Nigeria’s rate is still relatively high at about 630 when compared with the figures of the developed countries. For inclusive growth to be achieved in Nigeria, women should not be neglected and marginalized so they can contribute their quota to the growth of the country, but maternal mortality rate needs to be reduced because it is only the living that can make contributions to growth. Thus, this study examined the long run effect of gender inequality, maternal mortality and inclusive growth in Nigeria using time series data spanning from 1985 to 2017, and employed the ARDL econometric technique. The results showed that gender inequality and maternal mortality have negative impacts on inclusive growth in Nigeria. Therefore, the study recommends that women should be properly taken care of during pregnancy so that the maternal mortality rate can be reduced and hence they will be able to make meaningful contributions to the growth of the Nigerian economy.