Approximately 300.000 women die annually during pregnancy, childbirth or within 42 days
aft er the delivery. Most of these deaths occur in women living in low- and middle-income
countries (LMIC) in sub-Saharan African and South-East Asia, and could have been prevented
with access to quality maternal health care (Figure 1).1,2
Improving maternal health has been one of the global prioriti es since the adopti on of the
Millennium Development Goals (MDGs) in 2001 by the United Nati ons General Assembly.
However, despite substanti al progress with a 45% decline from 1990 to 2013, this sti ll falls
short of the intended 75% reducti on.3
In the MDGs successor, the Sustainable Development
Goals (SDGs) endorsed in 2015, maternal health conti nues to be a target with the ambiti on
to reduce the maternal mortality rati o (MMR) to less than 70 per 100.000 live births.4
The majority of maternal morbidity and mortality is caused by direct obstetric complicati
ons: postpartum hemorrhage (PPH), hypertensive disorders of pregnancy (HDP), sepsis
and unsafe aborti on.5
The relati ve contributi on of these causes are context-dependent,
with sepsis occurring relati vely more frequent in low resource setti ngs and declining with
bett er availability and quality of care. In contrast, hypertensive disorders of pregnancy and
indirect causes of mortality occur more oft en in middle- and high-income country setti ngs.
Underlying these proximal causes, are underlying economic, social, fi nancial, cultural and
clinical determinants.