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\"For twenty years, this \"beautifully written\" (USA Today), \"moving, comprehensive and insightful look at the lifelong ramifications of the loss of a mother\" (San Francisco Chronicle) has been the book a woman can turn to for understanding and comfort when her mother dies. Building on interviews with hundreds of motherless daughters, Hope Edelman's unique and courageous work also reflects her personal experience with the continued legacy of mother loss. An exploration of a profoundly life-altering rite-of-passage, Motherless Daughters is for any woman who wants to better understand the mother-daughter relationship. \"-- Provided by publisher.

Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100 000 livebirths globally by 2030. We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100 000 livebirths (80% UI 359–427) in 1990, to 216 (207–249) in 2015, corresponding to a relative decline of 43·9% (34·0–48·7), with 303 000 (291 000–349 000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0–3·1) in the Caribbean to 5·0% (4·0–6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100 000 livebirths (11–14) for high-income regions to 546 (511–652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%. Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths. National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Primate offspring often depend on their mothers well beyond the age of weaning, and offspring that experience maternal death in early life can suffer substantial reductions in fitness across the life span. Here, we leverage data from eight wild primate populations (seven species) to examine two underappreciated pathways linking early maternal death and offspring fitness that are distinct from direct effects of orphaning on offspring survival. First, we show that, for five of the seven species, offspring face reduced survival during the years immediately preceding maternal death, while the mother is still alive. Second, we identify an intergenerational effect of early maternal loss in three species (muriquis, baboons, and blue monkeys), such that early maternal death experienced in one generation leads to reduced offspring survival in the next. Our results have important implications for the evolution of slow life histories in primates, as they suggest that maternal condition and survival are more important for offspring fitness than previously realized.

Lucy Chappell and colleagues examine the dramatic reduction in maternal deaths from hypertensive disorders of pregnancy in the UK and discuss how systematic confidential inquiries may have contributed

Background The three delays model proposes that maternal mortality is associated with delays in: 1) deciding to seek care; 2) reaching the healthcare facility; and 3) receiving care. Previously, the majority of women who died were reported to have experienced type 1 and 2 delays. With increased coverage of healthcare services, we sought to explore the relative contribution of each type of delay. Method 151 maternal deaths were identified during a 12-month reproductive age mortality survey (RAMOS) conducted in Malawi; verbal autopsy and facility-based medical record reviews were conducted to obtain details about the circumstances surrounding each death. Using the three delays framework, data were analysed for women who had; 1) died at a healthcare facility, 2) died at home but had previously accessed care and 3) died at home and had not accessed care. Results 62.2% (94/151) of maternal deaths occurred in a healthcare facility and a further 21.2% (32/151) of mothers died at home after they had accessed care at a healthcare facility. More than half of all women who died at a healthcare facility (52.1%) had experienced more than one type of delay. Type 3 delays were the most significant delay for women who died at a healthcare facility or women who died at home after they had accessed care, and was identified in 96.8% of cases. Type 2 delays were experienced by 59.6% and type 1 delays by 39.7% of all women. Long waiting hours before receiving treatment at a healthcare facility, multiple delays at the time of admission, shortage of drugs, non-availability and incompetence of skilled staff were some of the major causes of type 3 delays. Distance to a healthcare facility was the main problem resulting in type 2 delays. Conclusion The majority of women do try to reach health services when an emergency occurs, but type 3 delays present a major problem. Improving quality of care at healthcare facility level will help reduce maternal mortality.

ObjectiveTo clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems.DesignDescriptive study.SettingMaternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG).ParticipantsWomen who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213).Main outcome measuresThe preventability and problems in each maternal death.ResultsMaternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1–3 h.ConclusionsA range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan.

Background Globally, most countries have policies and guidelines requiring maternal and perinatal death surveillance and response (MPDSR), a system that can reduce avoidable maternal and perinatal deaths. Economic studies of MPDSR help inform resources to implement and sustain MPDSR at subnational and national levels. This review aims to scope the range of economic studies available and examine types of costs incurred by LMICs to implement and maintain MPDSR. Methods We searched 11 electronic databases for key terms related to economics, maternal and/or perinatal death, health systems, surveillance, or audits/reviews. We included quantitative, qualitative, or mixed methods articles reporting costs of MPDSR, published in English, Spanish, or French during 2012–2023. Two independent authors screened titles and abstracts and extracted data. Costs were converted to the United States dollar price year 2024. Results A total of 14,078 articles were systematically screened. Only 5 were included, as they reported costs of maternal and/or perinatal death surveillance and/or review. Of these only 3 reported itemized costs. None reported on costs of implementing recommendations. From the articles reporting itemized costs, in year 1 (start-up), the cost per death reviewed ranged from $113 to $5,758 and the cost per capita ranged from $0.40 to $1.11. In year 3, these declined to $86 to $577, and $0.26 to $0.66, respectively. The lowest cost per death was for conducting only maternal death reviews in health facilities. For community MPDSR, the lowest cost per capita was achieved by using a pre-existing functional household surveillance system to identify and investigate maternal and neonatal deaths. The highest cost was for establishing a new comprehensive death surveillance and review system, which investigated all deaths in women of reproductive age to identify maternal deaths only. Conclusion Comparability was challenging because available literature was sparse and economic methods and study designs were heterogeneous. The cost–benefit of community death surveillance and review, compared to facility-based death notification and review, has not been clearly established. Better understanding of MPDSR costs is needed to prioritize and integrate MPDSR in health planning across system levels.

Background Despite declining trends maternal mortality remains an important public health issue in Mozambique. The delays to reach an appropriate health facility and receive care faced by woman with pregnancy related complications play an important role in the occurrence of these deaths. This study aims to examine the contribution of the delays in relation to the causes of maternal death in facilities in Mozambique. Methods Secondary analysis was performed on data from a national assessment on maternal and neonatal health that included in-depth maternal death reviews, using patient files and facility records with the most comprehensive information available. Statistical models were used to assess the association between delay to reach the health facility that provides emergency obstetric care (delay type II) and delay in receiving appropriate care once reaching the health facility providing emergency obstetric care (delay type III) and the cause of maternal death within the health facility. Results Data were available for 712 of 2,198 maternal deaths. Delay type II was observed in 40.4% of maternal deaths and delay type III in 14.2%.and 13.9% had both delays. Women who died of a direct obstetric complication were more likely to have experienced a delay type III than women who died due to indirect causes. Women who experienced delay type II were less likely to have also delay type III and vice versa. Conclusions The delays in reaching and receiving appropriate facility-based care for women facing pregnancy related complications in Mozambique contribute significantly to maternal mortality. Securing referral linkages and health facility readiness for rapid and correct patient management are needed to reduce the impact of these delays within the health system.

Background Unacceptably high levels of preventable maternal deaths persist across sub-Saharan Africa. Due to limited research on maternal mortality in Sudan, a thorough examination is crucial to develop effective reduction strategies. This study aims to analyze maternal mortality trends at national and subnational levels in Sudan from 2009 to 2019. Methods In this retrospective-comparative study, the researchers reviewed mortality data covering 2009 to 2019 from the reports issued by the national maternal death surveillance and response. The maternal mortality ratios for the national and state levels were adjusted based on the population of women of reproductive age. The trends were assessed for statistical significance using the Mann–Kendall test, implemented in Python (version 3.12). The cut-off p -value for significance was taken as < 0.05. Results The national maternal mortality ratio declined significantly by nearly 60% from 2009 to 2019 (S = -53, p <  0.001). The states of Kassala (S = -51, p <  0.001), Gadarif (S = -43, p <  0.001), Gezira (S = -41, p =  0.002), White Nile (S = -41, p =  0.002), Blue Nile (S = -39, p =  0.003), Red Sea (S = -39, p =  0.003), Khartoum (S = -39, p =  0.003), Northern State (S = -27, p =  0.043), River Nile (S = -27, p =  0.043), and Sinnar (S = -27, p =  0.043) showed significant declining trends. Blue Nile state recorded the highest average maternal mortality ratio in the study period (339.76), while Southern Darfur (66.46) and River Nile (89.59) recorded the lowest ratios. Major causes of maternal death include Obstetric hemorrhage (45.5%), hypertensive disorders (16%), and sepsis (12.6%). Important characteristics of pregnancy-related death include condition at admission, gestational age, antenatal care, mode of delivery, and areas of delay. Conclusions The national maternal mortality ratio significantly declined between 2009 and 2019, with wide regional disparities. Direct causes of maternal death remain a critical challenge. Effective strategies or frameworks focused on reducing maternal mortality ratios in Sudan are strongly solicited.

Background: An efficient, comprehensive emergency obstetrics care (CEMOC) can considerably reduce the burden of maternal mortality (MM) in Nigeria. Information about the risk of maternal death within 120 h of admission can reflect the quality of CEMOC offered. Aim: This study aims to determine the predictors and causes of maternal death within 120 h of admission at the Lagos University Teaching Hospital, LUTH, Lagos South-Western, Nigeria. Methods: We conducted a retrospective cohort study amongst consecutive maternal deaths at a hospital in South-Western Nigeria, from 1 January 2007 to 31 December 2017, using data from patients' medical records. We compared participants that died within 120 h to participants that survived beyond 120 h. Survival life table analysis, Kaplan-Meier plots and multivariable Cox proportional hazard regression were conducted to evaluate the factors affecting survival within 120 h of admission. Stata version 16 statistical software (StatCorp USA) was used for analysis. Results: Of the 430 maternal deaths, 326 had complete records. The mean age of the deceased was 30.7± (5.9) years and median time to death was 24 (5-96) h. Two hundred and sixty-eight (82.2%) women out of 326 died within 120 h of admission. Almost all maternal deaths from uterine rupture (95.2%) and most deaths from obstetric haemorrhage (87.3%), induced miscarriage (88.9%), sepsis (82.9%) and hypertensive disorders of pregnancy (77.9%) occurred within 120 h of admission. Admission to the intensive care unit (P = 0.007), cadre of admitting doctor (P < 0.001), cause of death (P = 0.036) and mode of delivery (P = 0.012) were independent predictors of hazard of death within 120 h. Conclusion: The majority (82.2%) of maternal deaths occurred within 120 h of admission. Investment in the prevention and acute management of uterine rupture, obstetric haemorrhage, sepsis and hypertensive disorders of pregnancy can help to reduce MM within 120 h in our environment.