10.2 Maternal and Infant Mortality

Maternal and infant mortality remains a critical public health issue worldwide. Factors like poverty, lack of education, and limited healthcare access contribute to higher death rates among mothers and babies, especially in developing countries.

Addressing these challenges requires a multifaceted approach. Public health interventions focus on improving prenatal care, increasing skilled birth attendance, and implementing community-based programs. Efforts also target socioeconomic disparities and cultural barriers to reduce mortality rates globally.

Maternal and infant mortality factors

Defining mortality and key causes

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  Infographic: The U.S. Maternal Health Care Crisis | Dr Fredda Branyon Scottsdale AZ View original

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  Infant Mortality - Our World In Data View original

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  Infant and Child Mortality in Rwanda - 2010 | National Institute of Statistics Rwanda View original

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  Infographic: The U.S. Maternal Health Care Crisis | Dr Fredda Branyon Scottsdale AZ View original

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Top images from around the web for Defining mortality and key causes

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  Infographic: The U.S. Maternal Health Care Crisis | Dr Fredda Branyon Scottsdale AZ View original

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• 

  Infant Mortality - Our World In Data View original

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  Infant and Child Mortality in Rwanda - 2010 | National Institute of Statistics Rwanda View original

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  Infographic: The U.S. Maternal Health Care Crisis | Dr Fredda Branyon Scottsdale AZ View original

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  Infant Mortality - Our World In Data View original

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• Maternal mortality encompasses deaths during pregnancy or within 42 days after pregnancy termination due to pregnancy-related causes
• Infant mortality refers to deaths before age one, typically expressed as deaths per 1,000 live births
• Direct obstetric causes of maternal deaths involve hemorrhage, hypertensive disorders, sepsis, and unsafe abortion complications
• Indirect maternal mortality causes include pre-existing conditions worsened by pregnancy (HIV/AIDS, malaria, cardiovascular diseases)
• Major contributors to infant mortality encompass preterm birth issues, congenital anomalies, intrapartum events, and infections (sepsis, pneumonia)

Socioeconomic and healthcare factors

• Poverty significantly impacts mortality through reduced access to care and poor nutrition
• Lack of education correlates with higher mortality rates due to limited health knowledge
• Inadequate healthcare access increases risks, especially in rural or underserved areas
• Poor nutrition during pregnancy and infancy raises mortality risks
• Quality of healthcare services plays a crucial role in outcomes
  • Skilled birth attendance improves survival chances
  • Emergency obstetric care availability reduces maternal deaths
  • Neonatal intensive care units lower infant mortality

Cultural and behavioral influences

• Traditional practices may delay seeking medical care (home births)
• Cultural beliefs about pregnancy and childbirth can affect health-seeking behaviors
• Stigma around certain conditions may prevent women from disclosing health issues
• Health literacy levels impact understanding of risks and proper care
• Maternal behaviors during pregnancy affect outcomes (smoking, alcohol use)

Disparities in maternal and infant health

Racial and socioeconomic disparities

• Racial and ethnic minorities often experience higher maternal and infant mortality rates
  • In the US, Black women face 3-4 times higher maternal mortality than white women
  • Native American and Alaska Native infants have nearly double the mortality rate of white infants
• Lower socioeconomic status strongly correlates with poorer health outcomes
  • Limited access to quality prenatal care
  • Higher rates of chronic health conditions
  • Increased exposure to environmental hazards
• Education level of mothers significantly predicts outcomes
  • Higher education associated with better health literacy and care-seeking
  • In many countries, infant mortality rates decrease as maternal education increases

Geographic and age-related disparities

• Urban-rural divides exist in access to quality maternal and infant care
  • Rural areas often lack specialized obstetric and neonatal facilities
  • Transportation barriers in remote regions delay emergency care
• Significant gaps persist between developed and developing countries
  • Maternal mortality ratio in low-income countries can be 20 times higher than in high-income countries
  • Sub-Saharan Africa and South Asia account for majority of global maternal deaths
• Age-related disparities create unique risks for certain groups
  • Adolescent mothers face higher risks of pregnancy complications and preterm birth
  • Advanced maternal age (35+) increases risks of gestational diabetes and chromosomal abnormalities

Intersectional factors and cultural influences

• Multiple social determinants intersect to compound health disparities
  • Race, poverty, and geographic location often overlap to create high-risk populations
  • Immigrant status may combine with language barriers and cultural differences to affect care
• Cultural practices and beliefs influence maternal and infant health outcomes
  • Some cultures prioritize traditional healers over modern medical care
  • Dietary restrictions during pregnancy may lead to nutritional deficiencies
  • Gender norms in certain societies may limit women's healthcare decision-making power
• Health system biases and discrimination can exacerbate disparities
  • Implicit bias among healthcare providers may affect quality of care for minority patients
  • Language barriers in healthcare settings can lead to misunderstandings and medical errors

Public health interventions for mortality

Prenatal and perinatal care initiatives

• Antenatal care programs provide regular check-ups, screenings, and education
  • Recommend at least 8 contacts during pregnancy for optimal outcomes
  • Include ultrasounds, blood tests, and gestational diabetes screening
• Skilled birth attendance initiatives aim for universal coverage
  • Train midwives and obstetricians in emergency obstetric care
  • Establish referral systems for complicated cases
• Emergency obstetric care systems offer rapid, high-quality interventions
  • Equip facilities with blood banks, operating theaters, and neonatal resuscitation equipment
  • Implement maternal and perinatal death surveillance and response systems

Preventive health measures

• Immunization programs protect mothers and infants
  • Maternal tetanus vaccination prevents neonatal tetanus
  • Infant immunizations target diseases like measles, polio, and rotavirus
• Nutrition interventions address malnutrition-related risks
  • Provide iron and folic acid supplementation during pregnancy
  • Promote exclusive breastfeeding for the first 6 months of life
• Family planning services prevent unintended pregnancies
  • Offer a range of contraceptive options
  • Educate on healthy birth spacing (at least 24 months between pregnancies)

Community-based and systemic approaches

• Community-based interventions extend care beyond facilities
  • Implement home visitation programs for high-risk mothers and infants
  • Train community health workers to provide basic care and referrals
• Health system strengthening efforts improve overall care quality
  • Invest in healthcare infrastructure and equipment
  • Enhance supply chains for essential medicines and supplies
  • Provide ongoing training for healthcare workers
• Health education campaigns raise awareness
  • Address topics like danger signs during pregnancy and importance of skilled birth attendance
  • Use multiple channels including mass media, community meetings, and school-based programs

Effectiveness of maternal and infant health strategies

Quantitative impact assessments

• Changes in maternal and infant mortality rates measure intervention impact
  • Global maternal mortality ratio decreased by 38% between 2000 and 2017
  • Under-5 mortality rate reduced by 59% from 1990 to 2018
• Cost-effectiveness analyses determine economic viability of strategies
  • Skilled birth attendance interventions often highly cost-effective in low-resource settings
  • Breastfeeding promotion shows excellent return on investment for child survival
• Comparative effectiveness research examines relative performance of interventions
  • Kangaroo mother care for preterm infants outperforms conventional incubator care in some contexts
  • Misoprostol for postpartum hemorrhage prevention compared to oxytocin in various settings

Qualitative and implementation assessments

• Patient satisfaction surveys provide insights on intervention acceptability
  • Assess women's experiences with antenatal care services
  • Gather feedback on respectful maternity care practices
• Implementation science approaches identify adoption barriers and facilitators
  • Examine healthcare worker adherence to new protocols
  • Assess supply chain challenges for essential medicines
• Long-term follow-up studies evaluate sustained impact
  • Track child development outcomes for infants who received early interventions
  • Monitor maternal health status years after pregnancy-related complications

Equity and systems-level evaluations

• Equity-focused evaluations examine disparity reduction
  • Assess whether interventions reach the most marginalized populations
  • Compare outcomes across different socioeconomic and ethnic groups
• Health system capacity assessments measure broader impacts
  • Evaluate improvements in emergency obstetric care readiness at facilities
  • Assess changes in healthcare worker knowledge and skills over time
• Policy and governance analyses examine enabling environments
  • Review implementation of maternal and child health policies
  • Assess coordination between different sectors (health, education, social services)