{{Short description|Health of women during pregnancy, child birth, and the postpartum period}} {{Use dmy dates|date=July 2025}} {{women's health sidebar}} '''Maternal health''' is the health of women during [[pregnancy]], [[childbirth]], and the [[postpartum period]]. In most cases, maternal health encompasses the [[health care]] dimensions of [[family planning]], [[Pre-conception counseling|preconception]], [[Prenatal care|prenatal]], and [[postnatal]] care in order to ensure a positive and fulfilling experience. In other cases, maternal health can reduce maternal morbidity and [[Maternal death|mortality]].{{sfn|WHO Maternal Health}} Maternal health revolves around the health and wellness of pregnant individuals, particularly when they are pregnant, at the time they give birth, and during child-raising. [[World Health Organization|WHO]] has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women develop health problems, sometimes resulting in death.<ref>{{Cite web |title= Maternal health |url=https://www.who.int/maternal-health/en/ |website=WHO |access-date=2020-05-14}}</ref> Because of this, there is a need to invest in the health of women. The investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and checking up on the health of individuals who have given birth.<ref>{{Cite journal |last1=Cohen |first1=Robert L. |last2=Murray |first2=John |last3=Jack |first3=Susan |last4=Arscott-Mills |first4=Sharon |last5=Verardi |first5=Vincenzo |date=2017-12-06 |title=Impact of multisectoral health determinants on child mortality 1980–2010: An analysis by country baseline mortality |journal=PLOS ONE |volume=12 |issue=12 |at=e0188762 |pmid=29211765 |pmc=5718556 |doi=10.1371/journal.pone.0188762 |doi-access=free |bibcode=2017PLoSO..1288762C |issn=1932-6203}}</ref> Maternal morbidity and mortality particularly affects women of color and women living in low and lower-middle income countries.<ref>{{Cite web |date=2022-04-11 |title=Working Together to Reduce Black Maternal Mortality {{!}} Health Equity Features |publisher =CDC |url=https://www.cdc.gov/healthequity/features/maternal-mortality/index.html |access-date=2022-09-12 |language=en-us}}</ref><ref>{{Cite web |title=Maternal mortality |url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality |access-date=2022-09-12 |publisher=WHO |language=en}}</ref>
== Maternal morbidity and mortality == WHO estimates that about 295,000 maternal deaths occurred in 2017.<ref name="Maternal health">{{Cite web |title=Maternal health |url=https://www.who.int/health-topics/maternal-health |access-date=2022-08-29 |website=www.who.int |language=en}}</ref> The causes of these maternal deaths range from severe bleeding to obstructed labour, all of which have highly effective interventions. Further, indirect causes of maternal mortality include anemia and malaria.<ref name="Maternal health"/> As women have gained access to family planning and skilled birth attendance with backup emergency obstetric care, the global maternal mortality has fallen by about 44 percent, which represented a decline of about 2.3 percent annually over the period from 1990 to 2015. While there has been a decline in worldwide mortality rates after much effort, high rates still exist, particularly in low and middle income countries (99%). [[Sub-saharan Africa]] accounts for approximately two thirds of these deaths and South Asia accounts for about one-fifth of them.<ref>{{cite web |title=Maternal Health |url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality |website=World Health Organisation |access-date=27 January 2023}}</ref> One third of the maternal deaths occur in India and Nigeria.<ref name="skolnic">{{cite book |last1=Skolnik |first1=Richard |title=Global Health 101 |date=2019 |publisher=Burlington: Jones & Bartlett Learning, LLC |isbn=978-1-284-14539-7 |pages=275–278 |edition=4th <!--|access-date=30 September 2020-->}}</ref> The mother's death results in vulnerable families, and their [[infant]]s, if they survive childbirth, are more likely to die before reaching their second birthday.<ref>{{Cite journal |last1=Moucheraud |first1=Corrina |last2=Worku |first2=Alemayehu |last3=Molla |first3=Mitike |last4=Finlay |first4=Jocelyn E |last5=Leaning |first5=Jennifer |last6=Yamin |first6=Alicia Ely |date=2015-05-06 |title=Consequences of maternal mortality on infant and child survival: a 25-year longitudinal analysis in Butajira Ethiopia (1987-2011) |journal=Reproductive Health |volume=12 |issue=Suppl 1 |pages=S4 |doi=10.1186/1742-4755-12-S1-S4 |issn=1742-4755 |pmc=4423767 |pmid=26001059 |doi-access=free }}</ref>
Both [[Maternal death|maternal mortality]] (death) and severe maternal morbidity (illness) are "associated with a high rate of preventability."<ref name="ACOG_SMFM_2016"/>
In 2010, the U.S. [[Joint Commission on Accreditation of Healthcare Organizations]] described maternal mortality as a "[[sentinel event]]", and uses it to assess the quality of a health care system.{{sfn|Joint Commission|2010}}
Subsidizing the cost of healthcare helps to improve the health status of women. In countries such as the U.S, U.K, and others, government and non-governmental bodies work to reduce and even eliminate fees for pregnant women or women who have health issues related to pregnancy. When women deliver their babies in certified healthcare facilities without paying or paying a very small amount, they can use their money on the diet of the baby, clothing, and other needs.<ref>{{cite journal |author1=Kristine Husøy Onarheim |author2=Johannesburg Helene Iversen |author3=David E Bloom |title=Economic Benefits of Investing in Women's Health: A Systematic Review. |journal=PLOS ONE |date=2016 |volume=30 |issue=3 |page=11 |doi=10.1371/journal.pone.0150120 |pmid=27028199 |pmc=4814064 |bibcode=2016PLoSO..1150120O |doi-access=free }}</ref> Also, when women attend clinics without charge and are issued free supplements, their health is maintained, and this reduces the monetary resources that the government invests in healthcare. In turn, the maternal morbidity rate, together with mortality rates, is lowered.<ref>{{Cite journal|last1=Onarheim|first1=Kristine Husøy|last2=Iversen|first2=Johanne Helene|last3=Bloom|first3=David E.|date=2016-03-30|title=Economic Benefits of Investing in Women's Health: A Systematic Review|journal=PLOS ONE|volume=11|issue=3|article-number=e0150120|doi=10.1371/journal.pone.0150120|pmid=27028199|pmc=4814064|bibcode=2016PLoSO..1150120O|issn=1932-6203|doi-access=free}}</ref>
Education on issues related to maternal health is essential to control and improve the healthcare of women. Women who have resources have a low chance of their health status deteriorating, due to their knowledge. These women are informed to make decisions regarding family planning, the best time to give birth as far as their financial capabilities are concerned, and their nutrition, before, during, and after giving birth. Additionally, many approaches involve women, families, and local communities as active stakeholders in interventions and strategies to improve maternal health.<ref>{{Cite journal |last1=Dada |first1=Sara |last2=Cocoman |first2=Olive |last3=Portela |first3=Anayda |last4=Brún |first4=Aoife De |last5=Bhattacharyya |first5=Sanghita |last6=Tunçalp |first6=Özge |last7=Jackson |first7=Debra |last8=Gilmore |first8=Brynne |date=2023-02-01 |title=What's in a name? Unpacking 'Community Blank' terminology in reproductive, maternal, newborn and child health: a scoping review |url=https://gh.bmj.com/content/8/2/e009423 |journal=BMJ Global Health |language=en |volume=8 |issue=2 |article-number=e009423 |doi=10.1136/bmjgh-2022-009423 |issn=2059-7908 |pmid=36750272|pmc=9906186 }}</ref> Gannon (n.p) reports that the maternal rate of mortality dropped by 70% between 1946 and 1953, when women began receiving maternal education. The study recommended that the focus should be on communities that are marginalized and girls who are under the age of 18. When the government manages to reduce unwanted and unplanned pregnancies among these two groups of people, it becomes easier to reduce maternal health problems and the cost associated with them.{{cn|date=April 2023}}
==Factors influencing maternal health== === Poverty and access to healthcare === According to a [[UNFPA]] report, social and economic status, culture norms and values, and geographic remoteness all increase maternal mortality, and the risk for maternal death (during pregnancy or childbirth) in sub-Saharan Africa is 175 times higher than in developed countries, and risk for pregnancy-related illnesses and negative consequences after birth is even higher.<ref name="Determinants">{{cite web|url=http://www.unfpa.org/sites/default/files/resource-pdf/EN-SRH%20fact%20sheet-Poormother.pdf|title=The social determinants of maternal death and disability|publisher=[[United Nations Population Fund]]}}</ref> [[Poverty]], maternal health, and outcomes for the child are all interconnected.<ref name="Filippi">{{cite journal | vauthors = Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, Koblinsky M, Osrin D | display-authors = 6 | title = Maternal health in poor countries: the broader context and a call for action | journal = Lancet | volume = 368 | issue = 9546 | pages = 1535–41 | date = October 2006 | pmid = 17071287 | doi = 10.1016/S0140-6736(06)69384-7 | s2cid = 31036096 }}</ref>
Women living in poverty-stricken areas are more likely to be [[Obesity|obese]] and engage in unhealthy behaviors such as [[cigarette smoking]] and substance use, are less likely to engage in or even have access to legitimate prenatal care, and are at a significantly higher risk for adverse outcomes for both the mother and child.<ref name=Timmermans>{{cite journal | vauthors = Timmermans S, Bonsel GJ, Steegers-Theunissen RP, Mackenbach JP, Steyerberg EW, Raat H, Verbrugh HA, Tiemeier HW, Hofman A, Birnie E, Looman CW, Jaddoe VW, Steegers EA | display-authors = 6 | title = Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods | journal = European Journal of Epidemiology | volume = 26 | issue = 2 | pages = 165–80 | date = February 2011 | pmid = 21203801 | pmc = 3043261 | doi = 10.1007/s10654-010-9542-5 }}</ref> A study conducted in Kenya observed that common maternal health problems in poverty-stricken areas include hemorrhaging, [[Anemia in pregnancy|anemia]], [[hypertension]], malaria, placenta retention, [[premature labor]], prolonged/complicated labor, and [[pre-eclampsia]].<ref name=Izugbara>{{cite journal | vauthors = Izugbara CO, Ngilangwa DP | title = Women, poverty and adverse maternal outcomes in Nairobi, Kenya | journal = BMC Women's Health | volume = 10 | issue = 33 | article-number = 33 | date = December 2010 | pmid = 21122118 | pmc = 3014866 | doi = 10.1186/1472-6874-10-33 | doi-access = free }}</ref>
====Prenatal care==== {{Main|Prenatal care}} [[File:Population Growth Rates, 2021.png|thumb|upright=1.5|Global rates of [[population growth]] and [[Population decline|decline]] (2021–2022); population growth rate takes [[Birth rate|birth]], [[Mortality rate|death]], and [[List of countries by net migration rate|migration]] rates into account. Future projections are based on the [[United Nations World Population Prospects]] (from 1950 until 2100).<ref>{{cite web |author1-last=Roser |author1-first=Max |author1-link=Max Roser |author2-last=Rodés-Guirao |author2-first=Lucas |date=May 2024 |title=Population growth rate, 2021 |url=https://ourworldindata.org/grapher/population-growth-rates?tab=map&year=2021 |url-status=live |website=www.ourworldindata.org |location=[[Oxford]], [[England]] |publisher=[[Our World in Data]] |archive-url=https://web.archive.org/web/20240520222646/https://ourworldindata.org/grapher/population-growth-rates?tab=map&year=2021 |archive-date=20 May 2024 |access-date=23 November 2025}}</ref>]] [[File:Total Fertility Rate Map by Country.svg|thumb|upright=1.5|Map of countries by [[List of sovereign states and dependencies by total fertility rate|total fertility rate]] (2022–2023), referring to the average number of children that are born to a woman over her lifetime, according to the [[Population Reference Bureau]].<ref>{{cite web |editor1-last=Kaneda |editor1-first=Toshiko |editor2-last=Greenbaum |editor2-first=Charlotte |editor3-last=Haub |editor3-first=Carl |date=October 2022 |title=2022 World Population Data Sheet |url=https://2022-wpds.prb.org/ |url-status=live |website=2022-wpds.prb.org |location=[[Washington, D.C.]] |publisher=[[Population Reference Bureau]] |archive-url=https://web.archive.org/web/20221007213329/https://2022-wpds.prb.org/ |archive-date=7 October 2022 |access-date=23 November 2025}}</ref>]]
Generally, adequate prenatal care encompasses medical care and educational, social, and nutritional services during pregnancy.<ref name=Alexander>{{cite journal |vauthors=Alexander G, Korenbrot CC |title=The Role of Prenatal Care in Preventing Low Birth Weight|journal=The Future of Children |date=Spring 1995 |volume=5 |issue=1 |pages=103–120 |jstor=1602510 |doi=10.2307/1602510 |pmid=7633858}}</ref> For example, prenatal care could include serum integrated screening tests for potential chromosomal abnormalities as well as blood pressure measurements, or uterus measurements to assess fetal growth. Although there are a variety of reasons women choose not to engage in proper prenatal care, 71% of low-income women in a US national study had difficulties getting access to prenatal care when they sought it out.<ref name=Alexander /> Additionally, immigrants and Hispanic women are at higher risk than white or black women for receiving little to no prenatal care, where level of education is also an indicator (since education and race are correlated). Adolescents are least likely to receive any prenatal care at all. Throughout several studies, women and adolescents ranked inadequate finances and lack of transportation as the most common barriers to receiving proper prenatal care.<ref name=Curry>{{cite journal |vauthors=Curry MA |title=Factors associated with inadequate prenatal care |journal=Journal of Community Health Nursing |volume=7 |issue=4 |pages=245–52 |year=1990 |pmid=2243268 |doi=10.1207/s15327655jchn0704_7 |jstor=3427223}}</ref>
Income is strongly correlated with quality of prenatal care.<ref name=Curry /> Sometimes, proximity to healthcare facilities and access to transportation have significant effects on whether or not women have access to prenatal care. An analysis conducted on maternal healthcare services in Mali found that women who lived in rural areas, far away from healthcare facilities were less likely to receive prenatal care than those who lived in urban areas. Furthermore, researchers found an even stronger relationship between lack of transportation and prenatal and delivery care.<ref name=Gage>{{cite journal |vauthors=Gage AJ |title=Barriers to the utilization of maternal health care in rural Mali |journal=Social Science & Medicine |volume=65 |issue=8 |pages=1666–82 |date=October 2007 |pmid=17643685 |doi=10.1016/j.socscimed.2007.06.001}}</ref> In addition to proximity being a predictor of prenatal care access, Materia and colleagues found similar results for proximity and antenatal care in rural Ethiopia.<ref name=Materia>{{cite journal |vauthors=Materia E, Mehari W, Mele A, Rosmini F, Stazi MA, Damen HM, Basile G, Miuccio G, Ferrigno L, Miozzo A |display-authors=6 | title=A community survey on maternal and child health services utilization in rural Ethiopia |journal=European Journal of Epidemiology |volume=9 |issue=5 |pages=511–6 |date=September 1993 |pmid=8307136 |doi=10.1007/bf00209529 |jstor=3520948 |s2cid=22107263}}</ref> Also, inadequate and poor quality services contributes in increasing maternal morbidity and mortality.<ref>{{cite web |title=maternal mortality |url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality |website=WHO |access-date=30 September 2020}}</ref>
=== Pre-existing conditions === ==== Pregestational diabetes ==== Pre-existing (pregestational) maternal Type 1 or Type 2 diabetes is a known factor that increases the risk of adverse outcomes, including pre-term birth, preeclampsia, and congenital birth defects.<ref name=":7">{{Cite journal |last1=Alexopoulos |first1=Anastasia-Stefania |last2=Blair |first2=Rachel |last3=Peters |first3=Anne L. |date=2019-05-14 |title=Management of Preexisting Diabetes in Pregnancy: A Review |journal=JAMA |volume=321 |issue=18 |pages=1811–1819 |doi=10.1001/jama.2019.4981 |issn=1538-3598 |pmc=6657017 |pmid=31087027}}</ref> Studies from the United States and Australia indicate that the prevalence of pregestational diabetes is around 1% of pregnancies.<ref name=":7" /><ref>{{Cite web |title=Epidemiology and Classification of Diabetes in Pregnancy {{!}} Article {{!}} GLOWM |url=http://www.glowm.com/article/heading/vol-8--maternal-medical-health-and-disorders-in-pregnancy--epidemiology-and-classification-of-diabetes-in-pregnancy/id/416413 |access-date=2022-08-29 |website=The Global Library of Women's Medicine |language=en}}</ref> Even healthy pregnancy causes a state of hyperglycemia. As a result, mothers with pregestational diabetes are at an increased risk for hyperglycemia.<ref>{{Cite journal |last1=Hartling |first1=Lisa |last2=Dryden |first2=Donna M. |last3=Guthrie |first3=Alyssa |last4=Muise |first4=Melanie |last5=Vandermeer |first5=Ben |last6=Donovan |first6=Lois |date=2013-07-16 |title=Benefits and Harms of Treating Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research |journal=Annals of Internal Medicine |volume=159 |issue=2 |pages=123–129 |doi=10.7326/0003-4819-159-2-201307160-00661 |pmid=23712381 |issn=0003-4819}}</ref><ref>{{Cite journal |journal=Mayo Clinic Proceedings |title=A Review of the Pathophysiology and Management of Diabetes in Pregnancy |url=https://www.mayoclinicproceedings.org/article/S0025-6196(20)30202-0/pdf |author1=Aoife M. Egan |author2=Margaret L. Dow |author3=Adrian Vella |date=December 2020 |volume=95 |issue=12 |pages=2734–2746 |doi=10.1016/j.mayocp.2020.02.019|pmid=32736942 }}</ref>
====HIV/AIDS==== Maternal HIV rates vary around the world, ranging from 1% to 40%, with African and Asian countries having the highest rates.<ref name=McIntyre2>{{cite journal |vauthors=McIntyre J |title=Maternal health and HIV |journal=Reproductive Health Matters |volume=13 |issue=25 |pages=129–35 |date=May 2005 |pmid=16035606 |doi=10.1016/s0968-8080(05)25184-4 |jstor=3776238 |s2cid=24802898}}</ref> Whilst maternal HIV infection largely has health implications for the child,<ref>{{cite book |url=https://www.unicef.org/sowc2013/ |year=2013 |title=The state of the world's children 2013 |location=Geneva |publisher=UNICEF}}</ref> especially in countries where poverty is high and education levels are low,<ref name="pmid22340362">{{cite journal |vauthors=Toure K, Sankore R, Kuruvilla S, Scolaro E, Bustreo F, Osotimehin B |title=Positioning women's and children's health in African union policy-making: a policy analysis |journal=Globalization and Health |volume=8 |page=3 |date=February 2012 |pmid=22340362 |pmc=3298467 |doi=10.1186/1744-8603-8-3 |doi-access=free}}</ref> having HIV/AIDS while pregnant can also cause heightened health risks for the mother.<ref>{{Cite web|url=https://www.hiv.gov/hiv-basics/hiv-prevention/reducing-mother-to-child-risk/preventing-mother-to-child-transmission-of-hiv|title=Preventing Mother-to-Child Transmission of HIV|website=HIV.gov|language=en|access-date=2018-11-07|date=2017-05-15}}</ref> A large concern for HIV-positive pregnant women is the risk of contracting tuberculosis (TB) and/or malaria, in developing countries.<ref name="McIntyre2" /> 28% of maternal deaths are from [[obstructed labour]] and indirect causes, meaning diseases that complicate pregnancy or that are complicated by pregnancy (malaria, anemia, HIV/AIDS, and cardiovascular diseases).<ref name="skolnic" />
====Maternal weight==== During pregnancy, women of an average pre-pregnancy weight ([[Body mass index|BMI]] 18.5-24.9) should expect to gain between {{convert|25|-|35|lb}} over the course of the pregnancy.<ref>{{Cite web|title=Weight Gain During Pregnancy {{!}} Pregnancy {{!}} Maternal and Infant Health {{!}} CDC |website=www.cdc.gov |url=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-weight-gain.htm |language=en-us |access-date=2019-03-28}}</ref> Increased rates of hypertension, diabetes, respiratory complications, and infections are prevalent in cases of maternal obesity and can have detrimental effects on pregnancy outcomes.<ref>{{cite journal |vauthors=Nodine PM, Hastings-Tolsma M |title=Maternal obesity: improving pregnancy outcomes |journal=MCN: The American Journal of Maternal/Child Nursing |volume=37 |issue=2 |pages=110–5 |date=2012 |pmid=22357072 |doi=10.1097/nmc.0b013e3182430296}}, cited in {{cite book |last=Santrock |first=John W |name-list-style=vanc |edition=14th |title=Life-Span Development |publisher=McGraw Hill |year=2013}}</ref> Obesity is an extremely strong risk factor for [[gestational diabetes]].<ref name=Chu>{{cite journal |vauthors=Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, Dietz PM |title=Maternal obesity and risk of gestational diabetes mellitus |journal=Diabetes Care |volume=30 |issue=8 |pages=2070–6 |date=August 2007 |pmid=17416786 |doi=10.2337/dc06-2559a |doi-access=free}}</ref> Research has found that obese mothers who lose weight (at least 10 pounds or 4.5 kg) between pregnancies reduce the risk of gestational diabetes during their next pregnancy, whereas mothers who gain weight actually increase their risk.<ref name=Glazer>{{cite journal |vauthors=Glazer NL, Hendrickson AF, Schellenbaum GD, Mueller BA |title=Weight change and the risk of gestational diabetes in obese women |journal=Epidemiology |volume=15 |issue=6 |pages=733–7 |date=November 2004 |pmid=15475723 |doi=10.1097/01.ede.0000142151.16880.03 |jstor=20485982 |s2cid=25998851 |doi-access=free}}</ref> Women who are pregnant should aim to exercise for at least 150 minutes per week, including muscle strengthening exercises.<ref>{{Cite web |url=https://www.niddk.nih.gov/health-information/weight-management/keep-active-eat-healthy-feel-great |title=Keep Active and Eat Healthy to Improve Well-being and Feel Great {{!}} NIDDK |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US|access-date=2019-03-28}}</ref> However, it is recommended that pregnant women discuss what exercise they can do safely with their OB/GYN in the early prenatal period.<ref>{{Cite web |title=Exercise During Pregnancy |website=www.acog.org |url=https://www.acog.org/en/womens-health/faqs/exercise-during-pregnancy |access-date=2022-08-29 |language=en}}</ref>
'''Vigorous Exercise'''
The current guidelines for moderate intensity activity during pregnancy have been outlined by organizations such as the WHO and ACOG to be the same 150 minutes per week as regular physical activity guidelines.<ref name=":03">{{Cite web |title=Physical Activity and Exercise During Pregnancy and the Postpartum Period |url=https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/04/physical-activity-and-exercise-during-pregnancy-and-the-postpartum-period |access-date=2024-11-14 |website=www.acog.org |language=en}}</ref> Certain modifications such as avoiding supine position after 20 weeks are also recommended.<ref name=":03" /> Vigorous activity guidelines during pregnancy have not been outlined as clearly or studied as much, so consulting a healthcare professional to get a safe, tailored, fitness plan is recommended. Current research supports that vigorous activity for most non-complicated singleton pregnancies is beneficial and has little negative impact on fetal wellbeing.<ref name=":16">{{Cite journal |last1=Szymanski |first1=Linda M. |last2=Satin |first2=Andrew J. |date=2012 |title=Strenuous exercise during pregnancy: is there a limit? |journal=American Journal of Obstetrics and Gynecology |language=en |volume=207 |issue=3 |pages=179.e1–179.e6 |doi=10.1016/j.ajog.2012.07.021|pmid=22939718 |pmc=3464969 }}</ref><ref name=":23">{{Cite journal |last1=Szumilewicz |first1=Anna |last2=Santos-Rocha |first2=Rita |last3=Worska |first3=Aneta |last4=Piernicka |first4=Magdalena |last5=Yu |first5=Hongli |date=2022 |title="How to HIIT while pregnant? The protocol characteristics and effects of high intensity interval training implemented during effects of high intensity interval training implemented during pregnancy – A systematic review" |url=https://www.balticsportscience.com/cgi/viewcontent.cgi?article=1000&context=journal |journal=Baltic Journal of Health and Physical Activity |volume=14}}</ref> It has also been shown to have similar benefits to those who perform the same level of activity outside of pregnancy.<ref name=":23" /> The concerns related to high intensity exercise during pregnancy are usually around fetal wellbeing measures such as heart rate and blood flow. No abnormal measures of fetal distress, such as heart rate or maternal/fetal blood flow<ref name=":16" />were found during high intensity/vigorous exercise, if the mother stayed under 90% of her heart rate maximum.<ref name=":23" /><ref name=":16" /> Risks of exceeding this heart rate included decreased uterine artery blood flow and fetal bradycardia.<ref name=":23" /><ref name=":33">{{Cite journal |last1=Beetham |first1=Kassia S. |last2=Giles |first2=Courtney |last3=Noetel |first3=Michael |last4=Clifton |first4=Vicki |last5=Jones |first5=Jacqueline C. |last6=Naughton |first6=Geraldine |date=2019 |title=The effects of vigorous intensity exercise in the third trimester of pregnancy: a systematic review and meta-analysis |journal=BMC Pregnancy and Childbirth |language=en |volume=19 |issue=1 |page=281 |doi=10.1186/s12884-019-2441-1 |doi-access=free |issn=1471-2393 |pmc=6686535 |pmid=31391016}}</ref> If using vigorous exercise as a means of lowering maternal weight gain during pregnancy, it's important to note there is little evidence to suggest that higher intensity has more of an effect than moderate intensity activity on normal pregnancies;<ref name=":33" /><ref name=":23" /> It was shown in one study that the obese/overweight population during pregnancy had improved maternal weight gain with more vigorous exercise compared to moderate although more studies are needed.<ref name=":33" /> When related to birth outcome measures such as mode of delivery, pain control, and duration all were unaffected when compared to moderate intensity.<ref name=":23" /><ref name=":33" />High intensity exercises such as stationary biking, uphill running, cross country skiing, and resistance circuit training, all showed similar benefits.<ref name=":33" /><ref name=":23" />
It is important to further study the effects and limitations of vigorous exercise during pregnancy as it becomes more prevalent for female athletes, and in the average population. Overall if one is already performing vigorous activity before pregnancy, no negative effects were found with the continuation of similar activity levels during pregnancy, if staying under 90% of the mothers heart rate maximum.<ref name=":16" /><ref name=":33" /><ref name=":23" /> Always consult a physician to ensure any physical activity performed is safe during pregnancy, as the recommended amount of physical activity can depend on other factors during pregnancy as well.
During and after pregnancy, mothers should receive continuous care from a physician, in-person or via telehealth depending on the need,<ref>{{Cite journal |last1=Cantor |first1=Amy G. |last2=Jungbauer |first2=Rebecca M. |last3=Totten |first3=Annette M. |last4=Tilden |first4=Ellen L. |last5=Holmes |first5=Rebecca |last6=Ahmed |first6=Azrah |last7=Wagner |first7=Jesse |last8=Hermesch |first8=Amy C. |last9=McDonagh |first9=Marian S. |date=2022-09-20 |title=Telehealth Strategies for the Delivery of Maternal Health Care: A Rapid Review |url=https://www.acpjournals.org/doi/10.7326/M22-0737 |journal=Annals of Internal Medicine |volume=175 |issue=9 |pages=1285–1297 |doi=10.7326/M22-0737 |issn=0003-4819 |pmid=35878405 |s2cid=251067668|url-access=subscription }}</ref> to monitor the growth and status of the fetus. Maternal health organizations suggest that at a minimum pregnant women should receive one ultrasound at week 24 to help predict any possible growth anomalies and prevent future gestational concerns.<ref name=":0" /> It is also stated that pregnant women should also fulfill any missing vaccinations as soon as possible including the tetanus vaccine and influenza vaccine.<ref>{{Cite book |title=Weekly Epidemiological Record Vol. 81 |date=20 November 2006 |publisher=World Health Organization |oclc=836405497}}</ref><ref>{{Cite journal |date=2012 |title=Vaccines Against Influenza |journal=Weekly Epidemiological Record |publisher=World Health Organization |volume=47}}</ref> For pregnant women who are at an increased risk for [[Pre-eclampsia]], one could take a dietary supplement of low dose aspirin as prophylaxis before 20 weeks gestation.<ref name=":0" /> Pregnant women should also monitor their blood sugars as they are able to monitor the potential development of gestational diabetes. Other prenatal screening tests include serum integrated protein tests, cell free DNA blood tests to check for chromosomal abnormalities, and nuchal translucency ultrasounds. If their medical system is able to provide them, mothers can also undergo more invasive diagnostic tests such as an amniocentesis, or chorionic villous sampling to detect abnormalities with greater accuracy.<ref>{{Cite journal |last1=Abel |first1=David Eric |last2=Alagh |first2=Amy |date=April 2020 |title=Benefits and limitations of noninvasive prenatal aneuploidy screening |journal=Journal of the American Academy of Physician Assistants |volume=33 |issue=4 |pages=49–53 |doi=10.1097/01.JAA.0000654208.03441.23 |issn=1547-1896 |pmid=32217908 |s2cid=214683494}}</ref><ref>{{Cite journal |last1=Jelin |first1=Angie C. |last2=Sagaser |first2=Katelynn G. |last3=Wilkins-Haug |first3=Louise |date=April 2019 |title=Prenatal Genetic Testing Options |journal=Pediatric Clinics of North America |volume=66 |issue=2 |pages=281–293 |doi=10.1016/j.pcl.2018.12.016 |issn=1557-8240 |pmid=30819336 |s2cid=73470036}}</ref>
=== Race and ethnicity === Research has demonstrated that '''discrimination in maternal care''' occurs on an international level. In Canada, female patients claim to have experienced sterilization without their consent, while other female patients have experienced neglect while hospitalized that eventually led up to their death. In the United States and the United Kingdom, research has shown that black individuals are more prone to experiencing discrimination in when receiving medical attention. This [[discrimination]] leads to imbalances in the way they get treated and often results in death. Africa also faces issues with gender discrimination, which leads to maternal mortality.
==== Statistics ==== Analysis of the Pregnancy Mortality Surveillance System, conducted by the Center for Disease Control and Prevention (CDC), indicates significant racial and ethnic disparities in pregnancy-related deaths.<ref name=":02">{{Cite web |date=4 February 2020 |title=Pregnancy Mortality Surveillance System {{!}} Maternal and Infant Health |url=https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm |access-date=24 April 2020 |publisher=Center for Disease Control and Prevention (CDC) |language=en-us |archive-date=5 February 2020 |archive-url=https://web.archive.org/web/20200205161305/https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm}}</ref> The pregnancy-related mortality ratio (PRMR) represents the number of deaths per 100,000 live births resulting from pregnancy or pregnancy-related causes. A 2019 report from the CDC shows that the PRMRs of Black women and Indigenous women in the United States are 3-4 times higher than that of White women. White women had a PRMR of approximately 13 maternal deaths per 100,000 live births. While Black and Indigenous women had PRMRs of 41 and 30 maternal deaths per 100,000 live births, respectively. The majority of these deaths were due to preventable diseases associated with pregnancy, such as hypertension. While the fatality rate of these diseases was higher among Black and Indigenous women, the initial prevalence was generally the same across all races.<ref name=":0222">{{cite journal |display-authors=6 |vauthors=Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, Shapiro-Mendoza C, Callaghan WM, Barfield W |date=September 2019 |title=Racial/Ethnic Disparities in Pregnancy-Related Deaths - United States, 2007-2016 |journal=MMWR. Morbidity and Mortality Weekly Report |language=en-us |volume=68 |issue=35 |pages=762–765 |doi=10.15585/mmwr.mm6835a3 |pmc=6730892 |pmid=31487273}}</ref> The Maternal Vulnerability Index (MVI) tool, which measures risk factors on a county-by-county basis in the U.S., confirms the racial disparities in maternal health outcomes.<ref>{{cite news |last1=Sgaier |first1=Sema |last2=Downey |first2=Jordan |date=17 November 2021 |title=What We See in the Shameful Trends on U.S. Maternal Health |newspaper=[[The New York Times]] |url=https://www.nytimes.com/interactive/2021/11/17/opinion/maternal-pregnancy-health.html}}</ref><ref>{{cite web |author=Surgo Ventures |title=Introducing the US Maternal Vulnerability Index |url=https://surgoventures.medium.com/introducing-the-us-maternal-vulnerability-index-54e6c415e441 |publisher=[[Medium (website)|Medium]] |date=26 October 2021}}</ref>
Although lower than that of Black and Indigenous women, the PRMR for Asian and Pacific Islander women was still slightly higher than that of the White women at 13.5.<ref name=":0222" /> The PRMR for Hispanic women has shown a decline in recent years. However, state-specific reports show that Hispanic women still face high rates of maternal morbidity, or health problems that arise from pregnancy and birth.<ref name=":12">{{cite journal |vauthors=Howell EA, Egorova NN, Janevic T, Balbierz A, Zeitlin J, Hebert PL |date=February 2017 |title=Severe Maternal Morbidity Among Hispanic Women in New York City: Investigation of Health Disparities |journal=Obstetrics and Gynecology |volume=129 |issue=2 |pages=285–294 |doi=10.1097/AOG.0000000000001864 |pmc=5380443 |pmid=28079772}}</ref>
==== Contributing factors ==== The CDC cites multiple causes for the racial gap in maternal mortality. They say that most pregnancy-related deaths are the combined result of 3-4 contributing factors. Some of these factors include higher rates of chronic conditions in minority communities,<ref name=":22">{{Cite journal |last=Petersen |first=Emily E. |date=2019 |title=Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016 |url=https://www.cdc.gov/mmwr/volumes/68/wr/mm6835a3.htm |journal=MMWR. Morbidity and Mortality Weekly Report |language=en-us |volume=68 |issue=35 |pages=762–765 |doi=10.15585/mmwr.mm6835a3 |pmid=31487273 |pmc=6730892 |issn=0149-2195}}</ref> lower rates of prenatal care,<ref name=":32">{{Cite web |first1=Samantha |last1=Artiga |first2=Olivia |last2=Pham |first3=Kendal |last3=Orgera |first4=Usha |last4=Ranji |date=2020-11-10 |title=Racial Disparities in Maternal and Infant Health: An Overview - Issue Brief |url=https://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-an-overview-issue-brief/ |access-date=2022-06-26 |website=KFF |language=en-US}}</ref> and lower rates of insurance coverage.<ref name=":32"/> Furthermore, teen pregnancy rates are higher in minority communities, which is a risk factor for pregnancy or birth complications.<ref name=":32"/> Black and Indigenous women can also encounter racial bias held by healthcare providers, which affects the quality of care given to treat or prevent a fatal disease. For example, an NIH report states that Black women are two to three times more likely to die of hemorrhage or embolisms during pregnancy or the postpartum period.<ref name=":62">{{Cite web |date=2021-08-12 |title=NIH-funded study highlights stark racial disparities in maternal deaths |url=https://www.nih.gov/news-events/news-releases/nih-funded-study-highlights-stark-racial-disparities-maternal-deaths |access-date=2022-04-08 |website=National Institutes of Health (NIH) |language=EN}}</ref> Outside of provider-patient interactions, structural factors can contribute to the racial gap in maternal mortality. This includes the gap in access to primary and preventative care as well as other social determinants of health such as education and community support.<ref name=":32"/> Chronic conditions such as high blood pressure and hypertension can cause pregnancy complications and maternal morbidity, and these conditions arise from the effects of the [[weathering hypothesis]].<ref>{{Cite web |title=State of Maternal Mortality: The Inequitable Burden on Black Mothers {{!}} The Pursuit {{!}} University of Michigan School of Public Health {{!}} Maternal Health {{!}} Child Health {{!}} Pregnancy {{!}} Reproductive Health {{!}} Health for Women {{!}} Health Care Access |url=https://sph.umich.edu/pursuit/2020posts/state-of-maternal-mortality-the-inequitable-burden-on-black-mothers.html |access-date=2024-12-03 |website=sph.umich.edu |language=en}}</ref> The weathering hypothesis also states a higher rate of preterm birth among Black pregnant people in the United States, which is not only dangerous for the baby but also has effects on the birth parent. A Black birth parent of a preterm baby is more likely to experience high blood pressure following a preterm birth and subsequent higher rates of coronary artery calcification.<ref>{{Cite journal |last1=Catov |first1=Janet M. |last2=Snyder |first2=Gabrielle G. |last3=Fraser |first3=Abigail |last4=Lewis |first4=Cora E. |last5=Liu |first5=Kiang |last6=Althouse |first6=Andrew D. |last7=Bertolet |first7=Marnie |last8=Gunderson |first8=Erica P. |date=July 2018 |title=Blood Pressure Patterns and Subsequent Coronary Artery Calcification in Women Who Delivered Preterm Births |journal=Hypertension |volume=72 |issue=1 |pages=159–166 |doi=10.1161/HYPERTENSIONAHA.117.10693 |pmc=6002920 |pmid=29792302}}</ref>
====Africa==== Research has demonstrated that Africa experiences discrimination in healthcare.<ref name=":2a">{{Cite journal |last1=Oduenyi |first1=Chioma |last2=Banerjee |first2=Joya |last3=Adetiloye |first3=Oniyire |last4=Rawlins |first4=Barbara |last5=Okoli |first5=Ugo |last6=Orji |first6=Bright |last7=Ugwa |first7=Emmanuel |last8=Ishola |first8=Gbenga |last9=Betron |first9=Myra |date=March 4, 2021 |title=Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment |journal=BMC Health Services Research |language=en |volume=21 |issue=1 |article-number=198 |doi=10.1186/s12913-021-06204-x |pmid=33663499 |pmc=7934485 |doi-access=free |issn=1472-6963}}</ref> Mothers experience gender-based discrimination, which affects the care a mom is receiving.<ref name=":2a" /> In 2017, Bolren alongside other researchers conducted a study and discovered that a majority of women in Nigeria have experienced abuse: emotional and physical.<ref name=":2a" /> Women have claimed to have delivered babies on the ground and some have claimed to have been neglected and not received medical attention.<ref name=":2a" /> According to a research study conducted in South East Nigeria, a provider's care is a major contributing factor to why Nigerian women do not seek medical attention relating to maternal and child-health services.<ref name=":2a" /> Providers often require a husband's permission before women are subjected to the use of [[Birth control|contraceptives]].<ref name=":2a" /> Women are forced to follow what their husbands say, so it poses obstacles in the manner a woman receives obstetric care.<ref name=":2a" />
==== Canada ==== Indigenous people have a higher likelihood of passing away or developing a non-treatable illness compared to folks who are White.<ref name=":0a">{{Cite web |title=Death of Joyce Echaquan {{!}} Research Starters {{!}} EBSCO Research |url=https://www.ebsco.com/ |access-date=2025-12-08 |website=EBSCO |language=en}}</ref> Stereotypes such as them being prone to addiction, being irresponsible parents, or abuse the healthcare system frequently are held by workers in the healthcare industry.<ref name=":0a" /> Canadians with Indigenous ancestry often avoid receiving care to prevent experiencing racism.<ref name=":0a" /> In Canada, studies have shown that 85% of people of Indigenous descent suffer from racism in a healthcare setting, and the neglect often paves the way for death to occur.<ref>{{Cite journal |last1=Thirsk |first1=Lorraine M. |last2=Panchuk |first2=Julia T. |last3=Stahlke |first3=Sarah |last4=Hagtvedt |first4=Reidar |date=2022-09-01 |title=Cognitive and implicit biases in nurses' judgment and decision-making: A scoping review |url=https://www.sciencedirect.com/science/article/pii/S0020748922001134 |journal=International Journal of Nursing Studies |volume=133 |article-number=104284 |doi=10.1016/j.ijnurstu.2022.104284 |pmid=35696809 |issn=0020-7489|doi-access=free }}</ref>
Joyce Echequan, an Indigenous woman, died as a result of the discrimination she experienced in a hospital in Quebec, Canada.<ref name=":1a">{{Cite news |last=Cecco |first=Leyland |date=2021-10-06 |title='Dead because she was Indigenous': Québec coroner says Atikemekw woman a victim of systemic racism |url=https://www.theguardian.com/world/2021/oct/06/joyce-echaquan-coroner-indigenous-systemic-racism-death |access-date=2025-11-17 |work=The Guardian |language=en-GB |issn=0261-3077}}</ref> A coroner claims if she were white, Echequan would be alive.<ref name=":1a" /> Echequan was admitted into the hospital for suffering from a heart condition, but was forced to livestream her stay after workers overlooked her pain, even after it escalated.<ref name=":1a" /> Echequan died from a rare heart disease known as [[Pulmonary edema|pulmonary oedema]].<ref name=":1a" /> She died as a result of her symptoms being deemed as minor and assumed her symptoms derived as a result of withdrawals from narcotic usage.<ref name=":1a" /> In 2020, Echequan was screaming from being in pain and was verbally abused by the nurses.<ref name=":0a" /> A lady attempting to get Echequan help was silenced by the nurses.<ref name=":0a" /> Echquan could not understand French and had difficulty understanding what workers were saying, so she would live-stream her stays at the hospital and later had her cousin translate them.<ref name=":0a" />
Moreover, women have claimed they have experienced female sterilization against their consent.<ref name=":0a" /> In 2007, an Indigenous mother was subjected to a [[tubal ligation]] without her consent after giving birth.<ref name=":0a" />
====United Kingdom==== According to an empirical research conducted by the [[Journal of Advanced Nursing]], people of color are more likely to experience complications from pregnancy or experience child mortalities solely based on their race and ethnicity.<ref>{{Cite journal |last1=MacLellan |first1=Jennifer |last2=Collins |first2=Sarah |last3=Myatt |first3=Margaret |last4=Pope |first4=Catherine |last5=Knighton |first5=Wanja |last6=Rai |first6=Tanvi |date=2022 |title=Black, Asian and minority ethnic women's experiences of maternity services in the UK: A qualitative evidence synthesis |journal=Journal of Advanced Nursing |language=en |volume=78 |issue=7 |pages=2175–2190 |doi=10.1111/jan.15233 |issn=1365-2648 |pmc=9314829 |pmid=35332568}}</ref> Stereotypes and implicit biases, for of discrimination, affect the ability for women to speak up.<ref name=":4a"/> Female patients in the United Kingdom have claimed that they have experienced microaggressions, neglect in their pain treatment, and stereotypes about their biology being able to withstand higher levels of pain.<ref name=":3a">{{Cite web |date=2022-05-24 |title='I feel like I'm going to war when I go into hospital' |url=https://www.kentonline.co.uk/tunbridge-wells/news/i-feel-like-im-going-to-war-when-i-go-into-hospital-267648/ |access-date=2025-12-08 |website=Kent Online |language=en}}</ref>
Tinu Alikor, a mother of three, lost an abnormal amount of blood during the last three months of her pregnancy, which led to her seeking medical attention.<ref name=":3a" /> Doctors deemed it as a thing that was not that important to look at, since Alikor had a [[urinary tract infection]].<ref name=":3a" /> Weeks after being discharged, she was hospitalized for two weeks and received blood transfusions due to the blood she lost.<ref name=":3a" /> The doctor had claimed she had “refused to be examined,” but Alikor refutes that claim as she begged medical providers to examine her for her abnormal loss of blood.<ref name=":3a" /> Similarly, during Alikor's second pregnancy, she experienced neglect once again.<ref name=":3" /> She was seeking some sort of pain reliever, but was not deemed as important to take care of until her child's head popped out.<ref name=":3a" />
High pain tolerances are a common stereotype that is often associated with Black women according to a report from Birthrights.<ref name=":3a" /> Women and babies are described to have tougher and thicker skin.<ref name=":3a" /> White people are commonly used in medicine, which makes it difficult for conditions like [[jaundice]] to be diagnosed in Black bodies.<ref name=":3a" /> Asian women are stereotyped as people who can not withstand the pain and weak.<ref name=":4a">{{Cite web |date=2022-05-22 |title='I was repeatedly ignored' - report finds maternity racism |url=https://www.bbc.com/news/health-61497923 |access-date=2025-12-08 |website=www.bbc.com |language=en-GB}}</ref> Asians and black women are more prone to dying from childbirth than a white women.<ref name=":4a" />
According to the report from Birthrights, a 31-year-old mom received care a day after she had developed [[sepsis]] after being induced.<ref name=":4a" /> She experienced symptoms like body aches and [[tachycardia]], but was told it was “normal."<ref name=":4a" /> Her baby was rushed into the neonatal intensive care unit to treat the sepsis infection it had acquired as well.<ref name=":4a" />
==== United States ==== Some providers in the United States believe Black women have different [[embryology]], sturdier bones, nerve endings that are less sensitive, and thicker skin, and hence, do not require much attention.<ref name="liebertpub.com">{{Cite journal |last1=Saluja |first1=Bani |last2=Bryant |first2=Zenobia |date=February 2021 |title=How Implicit Bias Contributes to Racial Disparities in Maternal Morbidity and Mortality in the United States |url=https://www.liebertpub.com/doi/10.1089/jwh.2020.8874 |journal=Journal of Women's Health |volume=30 |issue=2 |pages=270–273 |doi=10.1089/jwh.2020.8874 |pmid=33237843 |issn=1540-9996|doi-access=free }}</ref> Alongside, white individuals have higher rates to receive pain treatment ([[Epidural administration|epidurals]]) during labor, than a woman who is Black or Hispanic.<ref name="liebertpub.com"/> White women are 2.5 times less likely to die from a death that is related to their pregnancy compared to Black women.<ref name="blog.dol.gov">{{Cite web |title=For Black Women, Implicit Racial Bias in Medicine May Have Far-Reaching Effects |url=https://blog.dol.gov/2022/02/07/for-black-women-implicit-racial-bias-in-medicine-may-have-far-reaching-effects |archive-url=http://web.archive.org/web/20250911032653/https://blog.dol.gov/2022/02/07/for-black-women-implicit-racial-bias-in-medicine-may-have-far-reaching-effects |archive-date=2025-09-11 |access-date=2025-11-17 |website=DOL Blog |language=en}}</ref> It was harder for providers to acknowledge when a Black mother was in pain because it was harder to visualize it in their faces.<ref name="blog.dol.gov"/> Furthermore, Black women experience longer recovery times due to being treated differently, and often lead to their leave of absence time being extended, which can often lead them to be fired, affecting them financially.<ref name="blog.dol.gov"/>
=== Religion === There are many factors that influence maternal health and the access of resources. One of these factors that recent studies have highlighted is religion. For example, one such study stated that, due to the insensitivity and lack of knowledge that physicians showed immigrant Muslim women in Canada, their health information and treatment suffered.<ref name=":2">{{cite journal | vauthors = Reitmanova S, Gustafson DL | title = "They can't understand it": maternity health and care needs of immigrant Muslim women in St. John's, Newfoundland | journal = Maternal and Child Health Journal | volume = 12 | issue = 1 | pages = 101–11 | date = January 2008 | pmid = 17592762 | doi = 10.1007/s10995-007-0213-4 | s2cid = 27789414 }}</ref> The health care that they received from physicians did not provide information in respect to their religious or cultural practices and did little to provide cultural adjustments and emotional support.<ref name=":2" /> In order to provide a safer and more comfortable environment for Muslim women, it was proven that they needed more support that would connect with the immigrant community and health-related information.<ref name=":2" /> Discrimination based on religion is a factor that effects the maternal health care of women from different backgrounds. There is not a lot of discussion on the studies that reflect the hardships that women go through in terms of their religion and maternal care. Stigmatizing certain maternal and reproductive practices is common within the context of religion. For example, in a study that focused on interviewing women who have had abortions, one participant used the word "guilt" 16 times in her one-hour interview.<ref name=":3">{{Cite journal| vauthors = Cockrill K, Nack A |date= December 2013 |title="I'm Not That Type of Person": Managing the Stigma of Having an Abortion |journal=Deviant Behavior|volume=34|issue=12|pages=973–990|doi=10.1080/01639625.2013.800423 |s2cid= 146483608 }}</ref> She cited that the cause of her guilt was because of her Catholic upbringing.<ref name=":3" /> The overall data showed that there was a strong relationship between religion and self-stigma.<ref name=":3" /> Among the women who identified as a practicing Christian, 65% made statements that proved self-stigma effects.<ref name=":3" /> There is a lot of stigma and norms regarding religion that, in turn, place women at risk when receiving health-care.<ref>{{cite journal | vauthors = Målqvist M | title = Preserving misconceptions or a call for action?--A hermeneutic re-reading of the Nativity story | journal = Global Health Action | volume = 8 | article-number = 30386 | date = 2015-12-24 | pmid = 26707126 | pmc = 4691587 | doi = 10.3402/gha.v8.30386 }}</ref> Other religious practices and traditions have shown to influence maternal health in a negative way. Practitioners of apostolicism in Zimbabwe have been associated with higher maternal mortality.<ref name=":5">{{cite journal | vauthors = Munyaradzi Kenneth D, Marvellous M, Stanzia M, Memory DM | title = Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe | journal = PLOS ONE | volume = 11 | issue = 8 | article-number = e0160170 | date = 2016-08-10 | pmid = 27509018 | pmc = 4979998 | doi = 10.1371/journal.pone.0160170 | bibcode = 2016PLoSO..1160170M | doi-access = free }}</ref> Results of a study showed the dangerous associations that religion may have on maternal health.<ref name=":5" /> The general trend shows that Apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care.<ref name=":5" /> There are delays in recognizing danger signs, deciding to seek care and receiving appropriate health care.<ref name=":5" /> Future studies can look at how societal traditions or expectations such as gender roles may combine with religion to result in poorer maternal health care.{{cn|date=April 2023}}
Although factors of religion can negatively influence maternal health care, other studies show the necessity of understanding different religious beliefs and practices. In Ghana, interviews of women showed the benefits of transparent religious beliefs and practices while pregnant and in labor.<ref name=":6">{{cite journal | vauthors = Aziato L, Odai PN, Omenyo CN | title = Religious beliefs and practices in pregnancy and labour: an inductive qualitative study among post-partum women in Ghana | journal = BMC Pregnancy and Childbirth | volume = 16 | issue = 1 | article-number = 138 | date = June 2016 | pmid = 27267923 | pmc = 4895969 | doi = 10.1186/s12884-016-0920-1 | doi-access = free }}</ref> Spiritual interventions done by pastors in pregnancy included prayer, revelations, reversing negative dreams, laying of hands and anointing women.<ref name=":6" /> Religious artifacts used among the women during pregnancy and labor were anointing oil, blessed water, stickers, blessed white handkerchief, blessed sand, Bible and Rosary.<ref name=":6" /> The women made many connections to these practices and to their religion such as God having the capability to reduce labor pain and to provide a safe and successful delivery.<ref name=":6" /> The results concluded that spirituality is an integral part of the care of pregnant women in Ghana.<ref name=":6" /> In order to ensure the safety of these women, their religious practices should not be in secrecy.<ref name=":6" /> The presence of artifacts implies that women do not have the freedom to practice their religion at home.<ref name=":6" /> It was concluded that pastors should be sensitive to their role in the labor process and that revelations and spiritual interventions should not lead to pregnancy or labor complications.<ref name=":6" /> Future studies in religion and maternal health care will focus on the role of pastors, familiar support, and the views of midwives or health care professionals in different societies around the world.
==Effects on child health and development== ===Prenatal health=== [[Prenatal care]] is an important part of basic maternal health care.<ref>{{Cite web|url=https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/prenatal-care-and-tests|title=Prenatal care and tests {{!}} womenshealth.gov|website=womenshealth.gov|language=en|access-date=2018-11-07|date=2016-12-13}}</ref> It is recommended expectant mothers receive at least four antenatal healthcare visits, in which a health worker can check for signs of illness – such as underweight, anaemia or infection – and monitor the health and status of the fetus.<ref name="unfpa.org">{{Cite web|url=http://www.unfpa.org/maternal-health|title=Maternal health|website=www.unfpa.org|language=en|access-date=2018-04-22}}</ref> During these visits, women are counselled on nutrition and hygiene to optimize their health prior to, and following, delivery. These visits can also include health maintenance of any pre-existing health conditions the woman may have had prior to becoming pregnant - such as diabetes, hypertension, or renal disease. In collaboration with her healthcare provider, the patient can develop a birth plan which outlines how to reach care and what to do in the event of an emergency.{{cn|date=April 2023}}
The model CenteringPregnancy (group prenatal care) is a relatively new addition to prenatal healthcare, and has shown to improve both birth outcomes and patient & provider satisfaction.<ref name=":13">{{Cite journal |last=Rotundo |first=Genie |date=December 2011 |title=Centering Pregnancy: The Benefits of Group Prenatal Care |journal=Nursing for Women's Health |volume=15 |issue=6 |pages=508–518 |doi=10.1111/j.1751-486x.2011.01678.x |pmid=22900691 |issn=1751-4851}}</ref> Specifically, a randomized controlled trial indicated a 33 percent reduction in preterm birth (n=995), and the decrease was even more pronounced for Black/African American participants.<ref>{{Cite journal |last1=Ickovics |first1=Jeannette R. |last2=Kershaw |first2=Trace S. |last3=Westdahl |first3=Claire |last4=Magriples |first4=Urania |last5=Massey |first5=Zohar |last6=Reynolds |first6=Heather |last7=Rising |first7=Sharon Schindler |date=August 2007 |title=Group Prenatal Care and Perinatal Outcomes |journal=Obstetrics & Gynecology |volume=110 |issue=2 |pages=330–339 |doi=10.1097/01.aog.0000275284.24298.23 |pmid=17666608 |pmc=2276878 |issn=0029-7844}}</ref> CenteringPregnancy provides physical exams, education, and peer support to a group of pregnant women who all have a similar due date.<ref name=":13" /> Research in race concordant group prenatal care (like the EMBRACE group at UCSF) has not yet been researched enough to indicate improved outcomes.<ref>{{Cite web |date=2020-06-16 |title=EMBRACE: Perinatal Care for Black Families |url=https://womenshealth.ucsf.edu/coe/embrace-perinatal-care-black-families |access-date=2022-09-12 |website=UCSF Womens Health}}</ref> Nonetheless, race concordant care has been proven to improve patient experience<ref>{{Cite journal |last1=Takeshita |first1=Junko |last2=Wang |first2=Shiyu |last3=Loren |first3=Alison W. |last4=Mitra |first4=Nandita|author4-link=Nandita Mitra |last5=Shults |first5=Justine |last6=Shin |first6=Daniel B. |last7=Sawinski |first7=Deirdre L. |date=2020-11-09 |title=Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings |journal=JAMA Network Open |language=en |volume=3 |issue=11 |pages=e2024583 |doi=10.1001/jamanetworkopen.2020.24583 |issn=2574-3805 |pmc=7653497 |pmid=33165609}}</ref> and patient & provider communication.<ref>{{Cite journal |last1=Shen |first1=Megan Johnson |last2=Peterson |first2=Emily B. |last3=Costas-Muñiz |first3=Rosario |last4=Hernandez |first4=Migda Hunter |last5=Jewell |first5=Sarah T. |last6=Matsoukas |first6=Konstantina |last7=Bylund |first7=Carma L. |date=February 2018 |title=The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature |journal=Journal of Racial and Ethnic Health Disparities |language=en |volume=5 |issue=1 |pages=117–140 |doi=10.1007/s40615-017-0350-4 |issn=2197-3792 |pmc=5591056 |pmid=28275996}}</ref> Newborn-physician racial concordance was significantly associated with mortality improvements for black infants in 2020,<ref>{{Cite journal |last1=Greenwood |first1=Brad N. |last2=Hardeman |first2=Rachel R. |last3=Huang |first3=Laura |last4=Sojourner |first4=Aaron |date=September 2020 |title=Physician–patient racial concordance and disparities in birthing mortality for newborns |journal=Proceedings of the National Academy of Sciences |language=en |volume=117 |issue=35 |pages=21194–21200 |doi=10.1073/pnas.1913405117 |issn=0027-8424 |pmc=7474610 |pmid=32817561|bibcode=2020PNAS..11721194G |doi-access=free }}</ref> but debunked in 2024.<ref>Physician–patient racial concordance and newborn mortality. George J. Borjas & Robert VerBruggen, 16 September 2024, https://www.pnas.org/doi/10.1073/pnas.2409264121</ref><ref>{{cite news|access-date=20 May 2025 |date=27 October 2024 |language=en |quote=Although the authors of the original 2020 study had controlled for various factors, they had not included very low birth weight (ie, babies born weighing less than 1,500 grams, who account for about half of infant mortality). Once this was also taken into consideration, there was no measurable difference in outcomes |title=The data hinted at racism among white doctors. Then scholars looked again |url=https://www.economist.com/united-states/2024/10/27/the-data-hinted-at-racism-among-white-doctors-then-scholars-looked-again |newspaper=[[The Economist]]}}<!-- auto-translated from Spanish by Module:CS1 translator --></ref>
Poverty, malnutrition, and substance use may contribute to impaired cognitive, motor, and behavioral problems across childhood.<ref name=Hurt>{{cite journal | vauthors = Hurt H, Brodsky NL, Roth H, Malmud E, Giannetta JM | title = School performance of children with gestational cocaine exposure | journal = Neurotoxicology and Teratology | volume = 27 | issue = 2 | pages = 203–11 | year = 2005 | pmid = 15734271 | doi = 10.1016/j.ntt.2004.10.006 | bibcode = 2005NTxT...27..203H }}</ref> In other words, if a mother is not in optimal health during the prenatal period (the time while she is pregnant) and/or the fetus is exposed to teratogen(s), the child is more likely to experience health or developmental difficulties, or death. The environment in which the mother provides for the embryo/fetus is critical to its wellbeing well after gestation and birth.
A [[Teratology|teratogen]] is "any agent that can potentially cause a birth defect or negatively alter cognitive and behavioral outcomes."<ref>{{cite book |title=Understanding Genetics: A District of Columbia Guide for Patients and Health Professionals t of Columbia |chapter=Teratogens/Prenatal Substance Abuse |date=17 February 2010 |url=https://www.ncbi.nlm.nih.gov/books/NBK132140/ |publisher=Genetic Alliance |access-date=27 January 2023}}</ref> Dose, genetic susceptibility, and time of exposure are all factors for the extent of the effect of a teratogen on an embryo or fetus.<ref name=Santrock>{{cite book|last=Santrock|first=John W. | name-list-style = vanc |title=Life-Span Development|year=2013|publisher=McGraw Hill|location=New York, NY|isbn=978-0-07-131868-6|pages=82–83|edition=14th }}</ref>
Prescription drugs taken during pregnancy such as streptomycin, tetracycline, some antidepressants, progestin, synthetic estrogen, and Accutane,<ref name="Crijns_2012">{{cite journal | vauthors = Crijns HJ, van Rein N, Gispen-de Wied CC, Straus SM, de Jong-van den Berg LT | title = Prescriptive contraceptive use among isotretinoin users in the Netherlands in comparison with non-users: a drug utilisation study | journal = Pharmacoepidemiology and Drug Safety | volume = 21 | issue = 10 | pages = 1060–6 | date = October 2012 | pmid = 22228673 | doi = 10.1002/pds.3200 | s2cid = 35402923 | url = https://pure.rug.nl/ws/files/15052761/Crijns_2012_Pharmacoepidemiol_Drug_Saf.pdf }}</ref><ref name="Koren_2012">{{cite journal | vauthors = Koren G, Nordeng H | title = Antidepressant use during pregnancy: the benefit-risk ratio | journal = American Journal of Obstetrics and Gynecology | volume = 207 | issue = 3 | pages = 157–63 | date = September 2012 | pmid = 22425404 | doi = 10.1016/j.ajog.2012.02.009 }}</ref> as well as over-the-counter drugs such as diet pills, can result in teratogenic outcomes for the developing embryo/fetus. Additionally, high dosages of aspirin are known to lead to maternal and fetal bleeding, although low-dose aspirin is usually not harmful.<ref name=Bennett>{{cite journal | vauthors = Bennett SA, Bagot CN, Arya R | title = Pregnancy loss and thrombophilia: the elusive link | journal = British Journal of Haematology | volume = 157 | issue = 5 | pages = 529–42 | date = June 2012 | pmid = 22449204 | doi = 10.1111/j.1365-2141.2012.09112.x | s2cid = 10677131 | doi-access = free }}</ref><ref name=Marret>{{cite journal | vauthors = Marret S, Marchand L, Kaminski M, Larroque B, Arnaud C, Truffert P, Thirez G, Fresson J, Rozé JC, Ancel PY | display-authors = 6 | title = Prenatal low-dose aspirin and neurobehavioral outcomes of children born very preterm | journal = Pediatrics | volume = 125 | issue = 1 | pages = e29-34 | date = January 2010 | pmid = 20026499 | doi = 10.1542/peds.2009-0994 | doi-access = free }}</ref>
Newborns whose mothers use heroin during the gestational period often exhibit withdrawal symptoms at birth and are more likely to have attention problems and health issues as they grow up.<ref name=Blandthorn>{{cite journal | vauthors = Blandthorn J, Forster DA, Love V | title = Neonatal and maternal outcomes following maternal use of buprenorphine or methadone during pregnancy: findings of a retrospective audit | journal = Women and Birth | volume = 24 | issue = 1 | pages = 32–9 | date = March 2011 | pmid = 20864426 | doi = 10.1016/j.wombi.2010.07.001 }}</ref> Use of stimulants like methamphetamine and cocaine during pregnancy are linked to a number of problems for the child such as [[low birth weight]] and small head circumference, motor and cognitive developmental delays, as well as behavioral problems across childhood.<ref>{{cite book | vauthors = Field TM | year = 2007 | title = The amazing infant | location = Malden, MA | publisher = Blackwell }}</ref><ref name="Meyer_2009">{{cite journal | vauthors = Meyer KD, Zhang L | title = Short- and long-term adverse effects of cocaine abuse during pregnancy on the heart development | journal = Therapeutic Advances in Cardiovascular Disease | volume = 3 | issue = 1 | pages = 7–16 | date = February 2009 | pmid = 19144667 | pmc = 2710813 | doi = 10.1177/1753944708099877 }}</ref><ref name="pmid20600846">{{cite journal | vauthors = Richardson GA, Goldschmidt L, Leech S, Willford J | title = Prenatal cocaine exposure: Effects on mother- and teacher-rated behavior problems and growth in school-age children | journal = Neurotoxicology and Teratology | volume = 33 | issue = 1 | pages = 69–77 | date = 2011 | pmid = 20600846 | pmc = 3026056 | doi = 10.1016/j.ntt.2010.06.003 | bibcode = 2011NTxT...33...69R }}</ref><ref name="pmid21334365">{{cite journal | vauthors = Piper BJ, Acevedo SF, Kolchugina GK, Butler RW, Corbett SM, Honeycutt EB, Craytor MJ, Raber J | display-authors = 6 | title = Abnormalities in parentally rated executive function in methamphetamine/polysubstance exposed children | journal = Pharmacology, Biochemistry, and Behavior | volume = 98 | issue = 3 | pages = 432–9 | date = May 2011 | pmid = 21334365 | pmc = 3069661 | doi = 10.1016/j.pbb.2011.02.013 }}</ref> The [[American Academy of Child and Adolescent Psychiatry]] found that six-year-olds whose mothers had smoked during pregnancy scored lower on an intelligence test than children whose mothers had not.<ref name=Goldschmidt>{{cite journal | vauthors = Goldschmidt L, Richardson GA, Willford J, Day NL | title = Prenatal marijuana exposure and intelligence test performance at age 6 | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 47 | issue = 3 | pages = 254–263 | date = March 2008 | pmid = 18216735 | doi = 10.1097/chi.0b013e318160b3f0 }}</ref>
Cigarette smoking during pregnancy can have a multitude of detrimental effects on the health and development of the offspring. Common results of smoking during pregnancy include pre-term births, low birth weights, fetal and neonatal deaths, respiratory problems, and [[sudden infant death syndrome]] (SIDS),<ref name="Santrock"/> as well as increased risk for cognitive impairment, attention deficit hyperactivity disorder (ADHD) and other behavioral problems.<ref name=Abbott>{{cite journal | vauthors = Abbott LC, Winzer-Serhan UH | title = Smoking during pregnancy: lessons learned from epidemiological studies and experimental studies using animal models | journal = Critical Reviews in Toxicology | volume = 42 | issue = 4 | pages = 279–303 | date = April 2012 | pmid = 22394313 | doi = 10.3109/10408444.2012.658506 | s2cid = 38886526 }}</ref> Also, in a study published in the International Journal of Cancer, children whose mothers smoked during pregnancy experienced a 22% risk increase for non-Hodgkin lymphoma.<ref name=Antonopoulos>{{cite journal | vauthors = Antonopoulos CN, Sergentanis TN, Papadopoulou C, Andrie E, Dessypris N, Panagopoulou P, Polychronopoulou S, Pourtsidis A, Athanasiadou-Piperopoulou F, Kalmanti M, Sidi V, Moschovi M, Petridou ET | display-authors = 6 | title = Maternal smoking during pregnancy and childhood lymphoma: a meta-analysis | journal = International Journal of Cancer | volume = 129 | issue = 11 | pages = 2694–703 | date = December 2011 | pmid = 21225624 | doi = 10.1002/ijc.25929 | s2cid = 5251307 | doi-access = free }}</ref>
Although alcohol use in careful moderation (one to two servings a few days a week) during pregnancy are not generally known to cause [[fetal alcohol spectrum disorder]] (FASD), the US Surgeon General advises against the consumption of alcohol at all during pregnancy.<ref name=Cheng>{{cite journal | vauthors = Cheng D, Kettinger L, Uduhiri K, Hurt L | title = Alcohol consumption during pregnancy: prevalence and provider assessment | journal = Obstetrics and Gynecology | volume = 117 | issue = 2 Pt 1 | pages = 212–7 | date = February 2011 | pmid = 21252732 | doi = 10.1097/aog.0b013e3182078569 | s2cid = 13548123 }}</ref> Excessive alcohol use during pregnancy can cause FASD, which commonly consist of physical and cognitive abnormalities in the child such as facial deformities, defective limbs, face, and heart, learning problems, below average intelligence, and intellectual disability (ID).<ref name=Painter>{{cite journal | vauthors = Paintner A, Williams AD, Burd L | title = Fetal alcohol spectrum disorders-- implications for child neurology, part 1: prenatal exposure and dosimetry | journal = Journal of Child Neurology | volume = 27 | issue = 2 | pages = 258–63 | date = February 2012 | pmid = 22351188 | doi = 10.1177/0883073811428376 | s2cid = 46215913 }}</ref><ref>{{cite journal | vauthors = Paintner A, Williams AD, Burd L | title = Fetal alcohol spectrum disorders--implications for child neurology, part 2: diagnosis and management | journal = Journal of Child Neurology | volume = 27 | issue = 3 | pages = 355–62 | date = March 2012 | pmid = 22241713 | doi = 10.1177/0883073811428377 | s2cid = 40864343 }}</ref>
Although HIV/AIDS can be transmitted to offspring at different times, the most common time that mothers pass on the virus is during pregnancy. During the perinatal period, the embryo/fetus can contract the virus through the placenta.<ref name="Santrock"/>
[[Gestational diabetes]] is directly linked with obesity in offspring through adolescence.<ref name=Pettitt>{{cite journal | vauthors = Pettitt DJ, Baird HR, Aleck KA, Bennett PH, Knowler WC | title = Excessive obesity in offspring of Pima Indian women with diabetes during pregnancy | journal = The New England Journal of Medicine | volume = 308 | issue = 5 | pages = 242–5 | date = February 1983 | pmid = 6848933 | doi = 10.1056/NEJM198302033080502 }}</ref> Additionally, children whose mothers had diabetes are more likely to develop [[Type II diabetes]].<ref name=Dabelea>{{cite journal | vauthors = Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DJ | title = Increasing prevalence of Type II diabetes in American Indian children | journal = Diabetologia | volume = 41 | issue = 8 | pages = 904–10 | date = August 1998 | pmid = 9726592 | doi = 10.1007/s001250051006 | doi-access = free }}</ref> Mothers who have gestational diabetes have a high chance of giving birth to very large infants (10 pounds (4.5 kg) or more).<ref name="Santrock"/> This is a cause of macrosomia. Neonates with macrosomia have significantly increased rates of hypoglycemia compared to infants of mothers without diabetes. This is because macrosomic neonates are used to high levels of circulating blood sugars in utero, which results in naturally high levels of insulin. At birth, when the gestational source of blood sugar is abruptly removed, this causes the neonates to experience severe drops in blood sugar.<ref>{{Cite journal |last1=Mitanchez |first1=Delphine |last2=Yzydorczyk |first2=Catherine |last3=Simeoni |first3=Umberto |date=2015-06-10 |title=What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes? |journal=World Journal of Diabetes |volume=6 |issue=5 |pages=734–743 |doi=10.4239/wjd.v6.i5.734 |issn=1948-9358 |pmc=4458502 |pmid=26069722 |doi-access=free }}</ref>
Because the embryo or fetus's nutrition is based on maternal protein, vitamin, mineral, and total caloric intake, infants born to malnourished mothers are more likely to exhibit malformations. Additionally, maternal stress can affect the fetus both directly and indirectly. When a mother is under stress, physiological changes occur in the body that could harm the developing fetus. Additionally, the mother is more likely to engage in behaviors that could negatively affect the fetus, such as [[tobacco smoking]], substance use, and alcohol use.<ref name="Santrock"/>
===Childbirth and sexually transmitted infections=== [[Herpes genitalis|Genital herpes]], rubella, cytomegalovirus, varicella, parvovirus B19, and enteroviruses can be passed to the baby through the birth canal during delivery.<ref name="pmid21269306">{{cite journal | vauthors = Li JM, Chen YR, Li XT, Xu WC | title = Screening of Herpes simplex virus 2 infection among pregnant women in southern China | journal = The Journal of Dermatology | volume = 38 | issue = 2 | pages = 120–4 | date = February 2011 | pmid = 21269306 | doi = 10.1111/j.1346-8138.2010.00966.x | s2cid = 21282278 }}</ref><ref name="pmid21261443">{{cite journal | vauthors = Nigro G, Mazzocco M, Mattia E, Di Renzo GC, Carta G, Anceschi MM | title = Role of the infections in recurrent spontaneous abortion | journal = The Journal of Maternal-Fetal & Neonatal Medicine | volume = 24 | issue = 8 | pages = 983–9 | date = August 2011 | pmid = 21261443 | doi = 10.3109/14767058.2010.547963 | s2cid = 25192645 }}</ref><ref>{{Cite journal |last1=Neu |first1=Natalie |last2=Duchon |first2=Jennifer |last3=Zachariah |first3=Philip |date=March 2015 |title=TORCH Infections |url=https://linkinghub.elsevier.com/retrieve/pii/S0095510814001250 |journal=Clinics in Perinatology |language=en |volume=42 |issue=1 |pages=77–103 |doi=10.1016/j.clp.2014.11.001|pmid=25677998 |url-access=subscription }}</ref> In pregnancies where the mother is infected with the virus, 25% of babies delivered through an infected birth canal become brain damaged, and 1/3 die.<ref name=Santrock /> HIV/AIDS can also be transmitted during childbirth through contact with the mother's body fluids or transmission to the fetus via the placenta.<ref name=Santrock /> Mothers in developed countries may often elect to undergo a caesarean section to reduce the risk of transmitting the virus through the birth canal, but this option is not always available in developing countries.<ref name="McIntyre">{{cite journal | vauthors = McIntyre J, Gray G | title = What can we do to reduce mother to child transmission of HIV? | journal = BMJ | volume = 324 | issue = 7331 | pages = 218–21 | date = January 2002 | pmid = 11809646 | pmc = 1122134 | doi = 10.1136/bmj.324.7331.218 | jstor = 25227275 }}</ref>
===Postpartum period=== {{See also|Postpartum confinement|Sanhujori}} Globally, more than eight million of the 136 million women giving birth each year have excessive bleeding after childbirth.<ref name="Medicines">{{cite web|title=Medicines for Maternal Health |work=United Nations Population Fund |url=http://www.unfpa.org/publications/medicines-maternal-health|publisher=[[United Nations Population Fund|UNFPA]]}}</ref> This condition—medically referred to as postpartum hemorrhage (PPH)—causes one out of every four maternal deaths that occur annually and accounts for more maternal deaths than any other individual cause.<ref name="Medicines"/> Deaths due to postpartum hemorrhage disproportionately affect women in developing countries.
For every woman who dies from causes related to pregnancy, an estimated 20 to 30 encounter serious complications.<ref name="unfpa.org"/> At least 15 per cent of all births are complicated by a potentially fatal condition.<ref name="unfpa.org"/> Women who survive such complications often require lengthy recovery times and may face lasting physical, psychological, social and economic consequences. Although many of these complications are unpredictable, almost all are treatable. Findings from a 2023 systematic review of the literature have found a relationship between health insurance coverage and postpartum outcomes, suggesting that those with little to no coverage have increased negative postpartum health outcomes.<ref>{{Cite journal |last1=Saldanha |first1=Ian J. |last2=Adam |first2=Gaelen P. |last3=Kanaan |first3=Ghid |last4=Zahradnik |first4=Michael L. |last5=Steele |first5=Dale W. |last6=Chen |first6=Kenneth K. |last7=Peahl |first7=Alex F. |last8=Danilack-Fekete |first8=Valery A. |last9=Stuebe |first9=Alison M. |last10=Balk |first10=Ethan M. |date=2023-06-02 |title=Health Insurance Coverage and Postpartum Outcomes in the US: A Systematic Review |journal=JAMA Network Open |language=en |volume=6 |issue=6 |pages=e2316536 |doi=10.1001/jamanetworkopen.2023.16536 |issn=2574-3805 |pmc=10238947 |pmid=37266938}}</ref> .
During the [[postpartum period]], many mothers breastfeed their infants. Transmission of HIV/AIDS through breastfeeding is a huge issue in [[developing country|developing countries]], namely in African countries.<ref name=McIntyre /> The majority of infants who contract HIV through breast milk do so within the first six weeks of life,<ref name=Hollander>{{cite journal | vauthors = Hollander D | title = Most Infant HIV Infection from Breast Milk Occurs within Six Weeks of Birth|journal=International Family Planning Perspectives|date=September 2000|volume=26|issue=3|page=141|jstor=2648305|doi=10.2307/2648305}}</ref> despite that antiretroviral treatment (during pregnancy, delivery and during breastfeeding) reduces transmission risk by >90%. However, in healthy mothers, there are many benefits for infants who are breastfed. The World Health Organization recommends that mothers breastfeed their children for the first two years of life, whereas the American Academy of Pediatrics and the American Academy of Family Physicians recommend that mothers do so for at least the first six months, and continue as long as is mutually desired.<ref name=Stuebe&Schwarz>{{cite journal | vauthors = Stuebe AM, Schwarz EB | title = The risks and benefits of infant feeding practices for women and their children | journal = Journal of Perinatology | volume = 30 | issue = 3 | pages = 155���62 | date = March 2010 | pmid = 19609306 | doi = 10.1038/jp.2009.107 | doi-access = free }}</ref> Infants who are breastfed by healthy mothers (not infected with HIV/AIDS) are less prone to infections such as ''Haemophilus influenza, Streptococcus pneunoniae, Vibrio cholerae, Escherichia coli, Giardia lamblia'', group B streptococci, ''Staphylococcus epidermidis'', rotavirus, respiratory syncytial virus and herpes simplex virus-1, as well as gastrointestinal and lower respiratory tract infections and otitis media. Lower rates of infant mortality are observed in breastfed babies in addition to lower rates of sudden infant death syndrome (SIDS). Decreases in obesity and diseases such as childhood metabolic disease, asthma, atopic dermatitis, Type I diabetes, and childhood cancers are also seen in children who are breastfed.<ref name=Stuebe&Schwarz />
Following up on the women who have given birth is a crucial factor as it helps check on maternal health. Since healthcare facilities have records of the women who have given birth, when the women are followed to monitor the progress of their babies as well as their health, it becomes easy to put them on a follow-up and ensure they are doing well as the baby grows. Follow-up is accompanied by nutritional advice to ensure both the mother and her baby are in good condition. This prevents sickness that may affect the two and deteriorate their health.
Additionally, longitudinal followup must include mental health support and screening, as roughly 15% of women will experience [[postpartum depression]], also known as "baby blues", within the first year of birth, although it typically starts in the first 1–3 weeks after birth.<ref>{{Cite journal |last1=Frieder |first1=Ariela |last2=Fersh |first2=Madeleine |last3=Hainline |first3=Rachel |last4=Deligiannidis |first4=Kristina M. |date=March 2019 |title=Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development |journal=CNS Drugs |volume=33 |issue=3 |pages=265–282 |doi=10.1007/s40263-019-00605-7 |issn=1179-1934 |pmc=6424603 |pmid=30790145}}</ref><ref>{{Cite journal |last1=Gaynes |first1=B. N. |last2=Gavin |first2=N. |last3=Meltzer-Brody |first3=S. |author-link3=Samantha Meltzer-Brody |last4=Lohr |first4=K. N. |last5=Swinson |first5=T. |last6=Gartlehner |first6=G. |last7=Brody |first7=S. |last8=Miller |first8=W. C. |date=February 2005 |title=Perinatal depression: prevalence, screening accuracy, and screening outcomes |journal=Evidence Report/Technology Assessment (Summary) |issue=119 |pages=1–8 |doi=10.1037/e439372005-001 |issn=1530-440X |pmc=4780910 |pmid=15760246}}</ref><ref>{{Cite web |title=Postpartum Depression |url=https://www.acog.org/en/womens-health/faqs/postpartum-depression |access-date=2022-08-29 |website=www.acog.org |language=en}}</ref>
== Recommended maternal health practices == Maternal health care and care of the fetus starts with prenatal health. The World Health Organization suggests that the first step towards health is a balanced diet which includes a mix of vegetables, meat, fish, nuts, whole grains, fruits and beans.<ref name=":0">{{Cite web|title=WHO recommendations on maternal health: guidelines approved by the WHO guidelines review committee|url=https://apps.who.int/iris/bitstream/handle/10665/259268/WHO-MCA-17.10-eng.pdf;jsessionid=7577C2BF2CBB9E1729BA005E0EC7D20F?sequence=1|publisher=World Health Organization|date=2017|access-date=19 March 2020}}</ref> Additionally, iron supplements and folic acid are recommended to be taken by pregnant women daily. These supplements are recommended by the US Surgeon General to help prevent birth complications for mothers and babies such as low birth weight, anemia, [[hypertension]] and pre-term birth.<ref name=":4">{{Cite book|url=http://www.nap.edu/catalog/11622|title=Preterm Birth: Causes, Consequences, and Prevention|date=2007-04-23|publisher=National Academies Press|isbn=978-0-309-10159-2|location=Washington, D.C.|doi=10.17226/11622|pmid=20669423| author = Institute of Medicine (US) Committee on Understanding Premature Birth Assuring Healthy Outcomes| veditors = Behrman RE, Butler AS }}</ref><ref name=":0" /><ref>{{Cite web|title=Pregnancy Health: Exercise Programs to Prevent Gestational Hypertension|url=https://www.thecommunityguide.org/findings/pregnancy-health-exercise-programs-prevent-gestational-hypertension|date=2019-05-10|website=The Guide to Community Preventive Services (The Community Guide)|language=en|access-date=2020-04-29}}</ref> Folic acid can aid neural tube formation in a fetus, which happens early in gestation and therefore should be recommended as soon as possible.<ref name=":1">{{Cite web|title=WHO recommendations on antenatal care for a positive pregnancy experience|url=https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf?sequence=1|publisher=World Health Organization|date=2016|access-date=19 March 2020}}</ref> Calcium and Vitamin A supplements are also recommended when those compounds are not available or only available in low doses in the natural diet but other supplements such as Vitamins D, E, C, and B6 are not recommended.<ref name=":1" /> The WHO also suggests that low impact exercise and reduction of caffeine intake to less than 330 mg/day can help to reduce the likelihood of neonatal morbidity.<ref name=":0" /> Light exercise should be continued for pregnant mothers as it has been recommended to combat negative health outcomes, side effects and birth complications related to obesity.<ref name=":4" /> The overturned advice that pregnant women's heartate should not exceed 140 as of 2012 was still popularly believed.<ref>{{Cite journal |last1=Evenson |first1=Kelly |last2=Hesketh |first2=Kathryn |date=Jan–Feb 2023 |title=Monitoring Physical Activity Intensity During Pregnancy |journal=American Journal of Lifestyle Medicine |volume=17 |issue=1 |pages=18–31 |doi=10.1177/15598276211052277|pmid=36636387 |pmc=9830234 }}</ref><ref>{{Cite news |last=Vora |first=Shivani |date=5 July 2012 |title=Prenatal Fitness: Aerobics to Zumba |url=https://www.nytimes.com/2012/07/06/nyregion/staying-fit-while-pregnant-in-new-york.html |access-date=6 July 2024 |work=[[The New York Times]]}}</ref> Should possible side effects of a pregnancy occur, such as nausea, vomiting, heartburn, leg cramps, lower back pain, and constipation; low intensity exercise, balanced diet, or natural herb supplements are recommended by the WHO to mitigate the side effects.<ref name=":0" /> the US Surgeon General recommends abstaining from consuming alcohol or nicotine in any form throughout the duration of one's pregnancy, and to avoid using it as a way to mitigate some of the side effects of pregnancy mentioned earlier.<ref>{{Cite web|title=Surgeon General Releases Report on E-Cigarettes |publisher=National Alliance of State Pharmacy Associations (NASPA) |url=https://naspa.us/blog/2016/12/09/surgeon-general-releases-report-e-cigarettes/ |date=9 December 2016}}</ref><ref>{{cite web |title=E-Cigarettes and Pregnancy |url=https://www.cdc.gov/maternal-infant-health/pregnancy-substance-abuse/e-cigarettes.html |date=15 May 2024 |publisher=CDC}}</ref>
In the case of a healthy vaginal birth, mothers and babies typically are recommended to stay at the hospital for 24 hours before departing. This is suggested to allow time to assess the mother and child for any possible complications such as bleeding or additional contractions. The WHO recommends that babies should have checkups with a physician on day 3, day 7-14 and 6 weeks after birth.<ref name=":0" /> At these follow-up appointments the emotional well-being of the mother should also be considered. Special attention to the possibility of [[postpartum depression]], which affects 10-15% of mothers in 40 countries is also recommended by the WHO.<ref>{{cite journal | vauthors = Halbreich U, Karkun S | title = Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms | journal = Journal of Affective Disorders | volume = 91 | issue = 2–3 | pages = 97–111 | date = April 2006 | pmid = 16466664 | doi = 10.1016/j.jad.2005.12.051 | url = http://www.sciencedirect.com/science/article/pii/S0165032705004222 | url-access = subscription }}</ref> A 2021 systematic review of found that counseling interventions delivered by trained nonspecialist providers, such as nurses and midwives, were effective in reducing perinatal depression and anxiety symptoms, highlighting task-sharing and telemedicine to expand mental health care access for pregnant and postpartum women.<ref>{{Cite journal |last1=Singla |first1=Daisy R. |last2=Lawson |first2=Andrea |last3=Kohrt |first3=Brandon A. |last4=Jung |first4=James W. |last5=Meng |first5=Zifeng |last6=Ratjen |first6=Clarissa |last7=Zahedi |first7=Nika |last8=Dennis |first8=Cindy-Lee |last9=Patel |first9=Vikram |date=2021-05-01 |title=Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries: A Systematic Review and Meta-analysis |journal=JAMA Psychiatry |language=en |volume=78 |issue=5 |pages=498–509 |doi=10.1001/jamapsychiatry.2020.4556 |issn=2168-622X |pmc=7859878 |pmid=33533904}}</ref><ref>{{Cite journal |last1=Singla |first1=Daisy R. |last2=Silver |first2=Richard K. |last3=Vigod |first3=Simone N. |last4=Schoueri-Mychasiw |first4=Nour |last5=Kim |first5=J. Jo |last6=La Porte |first6=Laura M. |last7=Ravitz |first7=Paula |last8=Schiller |first8=Crystal E. |last9=Lawson |first9=Andrea S. |last10=Kiss |first10=Alex |last11=Hollon |first11=Steven D. |last12=Dennis |first12=Cindy-Lee |last13=Berenbaum |first13=Tara S. |last14=Krohn |first14=Holly A. |last15=Gibori |first15=Jamie E. |date=2025 |title=Task-sharing and telemedicine delivery of psychotherapy to treat perinatal depression: a pragmatic, noninferiority randomized trial |journal=Nature Medicine |language=en |volume=31 |issue=4 |pages=1214–1224 |doi=10.1038/s41591-024-03482-w |issn=1078-8956 |pmc=12003186 |pmid=40033113}}</ref> At these check ins mothers also have the opportunity to seek consultation from a physician about starting the breastfeeding process.<ref name=":1" />
== Long-term effects for the mother == Maternal health problems include complications from childbirth that do not result in death. For every woman that dies during childbirth, approximately 20 develop [[infection]], [[injury]], or [[disability]].<ref>{{cite web |title=Maternal deaths worldwide drop by third |date=15 September 2010 |publisher=World Health Organization |url=https://www.who.int/mediacentre/news/releases/2010/maternal_mortality_20100915/en/index.html|archive-url=https://web.archive.org/web/20100918223508/http://www.who.int/mediacentre/news/releases/2010/maternal_mortality_20100915/en/index.html|archive-date=18 September 2010}}</ref> Around 75% of women who die in childbirth would be alive today if they had access to pregnancy prevention and healthcare interventions.<ref>{{Cite journal|publisher=African Progress Panel|date=2010|title=Maternal Health: Investing in the Lifeline of Healthy Societies & Economies|url=https://www.who.int/pmnch/topics/maternal/app_maternal_health_english.pdf|journal=Africa Progress Panel}}</ref> Black women are more likely to experience pregnancy-related deaths as well as to receive less effective medical care during pregnancy.<ref>{{Cite journal |date=April 2018 |title=Snapshot: Black Maternal Health in the United States |url=https://nationalpartnership.org/wp-content/uploads/2023/02/maternity-snapshot-black-maternal-health.pdf |journal=Snapshot |publisher=National Partnership for Women & Families}}</ref>
Women who have chronic [[hypertension]] before their pregnancy are at increased risk of complications such as [[Preterm birth|premature birth]], [[Small for gestational age|low birthweight]] or [[stillbirth]].<ref>{{cite journal |vauthors=Al Khalaf SY, O'Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS |date=May 2021 |title=Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis |journal=Journal of the American Heart Association |volume=10 |issue=9 |article-number=e018494 |doi=10.1161/JAHA.120.018494 |pmc=8200761 |pmid=33870708}}</ref> Women who have high blood pressure and had complications in their pregnancy have three times the risk of developing [[cardiovascular disease]] compared to women with normal blood pressure who had no complications in pregnancy. Monitoring pregnant women's blood pressure can help prevent both complications and future cardiovascular diseases.<ref>{{Cite journal |date=2023-11-21 |title=Pregnancy complications increase the risk of heart attacks and stroke in women with high blood pressure |url=https://evidence.nihr.ac.uk/alert/pregnancy-complications-increase-the-risk-of-heart-attacks-and-stroke-in-women-with-high-blood-pressure/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_60660|s2cid=265356623 |url-access=subscription |doi-access=free }}</ref><ref>{{cite journal |vauthors=Al Khalaf S, Chappell LC, Khashan AS, McCarthy FP, O'Reilly ÉJ |date=July 2023 |title=Association Between Chronic Hypertension and the Risk of 12 Cardiovascular Diseases Among Parous Women: The Role of Adverse Pregnancy Outcomes |journal=Hypertension |volume=80 |issue=7 |pages=1427–1438 |doi=10.1161/HYPERTENSIONAHA.122.20628 |pmid=37170819|doi-access=free }}</ref>
Almost 50% of the births in developing countries still take place without a [[birth attendant|medically skilled attendant]] to aid the mother, and the ratio is even higher in South Asia.<ref name="UNICEF">{{harnvb|UNICEF Maternal Health}}</ref> Women in Sub-Saharan Africa mainly rely on [[traditional birth attendant]]s (TBAs), who have little or no formal health care training. In recognition of their role, some countries and non-governmental organizations are making efforts to train TBAs in maternal health topics, in order to improve the chances for better health outcomes among mothers and babies.<ref>{{cite web |title=Evaluation Findings: Support to traditional birth attendants |year=1996 |publisher=United Nations Population Fund |url=http://www.unfpa.org/monitoring/pdf/n-issue7.pdf |access-date=3 March 2011 |archive-date=2 December 2012 |archive-url=https://web.archive.org/web/20121202064549/http://www.unfpa.org/monitoring/pdf/n-issue7.pdf |url-status=dead }}</ref>
Breastfeeding provides women with several long-term benefits. Women who breastfeed experience better glucose levels, lipid metabolism, and blood pressure, and lose pregnancy weight faster than those who do not. Additionally, women who breastfeed experience lower rates of breast cancer, ovarian cancer, and type 2 diabetes.<ref name=Stuebe&Schwarz /> However, it is important to keep in mind that breastfeeding provides substantial benefits to women who are not infected with HIV. In countries where HIV/AIDS rates are high, such as South Africa and Kenya, the virus is a leading cause of maternal mortality, especially in mothers who breastfeed.<ref name=McIntyre /> A complication is that many HIV-infected mothers cannot afford formula, and thus have no way of preventing transmission to the child through breast milk or avoiding health risks for themselves.<ref name=Hollander /> In cases like this, mothers have no choice but to breastfeed their infants regardless of their knowledge of the harmful effects.
==Maternal Mortality Rate== {{see also | Maternal death}} [[File:Maternal mortality rate worldwide.jpg|thumb|upright=1.5|[[Maternal Mortality Rate]] worldwide, as defined by the number of maternal deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management, excluding accidental or incidental causes.<ref name=CIA2010>[https://web.archive.org/web/20111024112608/https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html?countryName=Australia&countryCode=as®ionCode=aus&rank=156#as Country Comparison: Maternal Mortality Rate] in [[:en:The World Factbook|The CIA World Factbook]]. Date of Information: 2010</ref>]] Worldwide, the [[maternal death|Maternal Mortality Ratio (MMR)]], which is defined as deaths per 100,000 live births per time-period, has decreased, with South-East Asia seeing the most dramatic decrease of 59% and Africa seeing a decline of 27%. There are no regions that are on track to meet the Millennium Development Goal of decreasing maternal mortality by 75% by the year 2015.<ref>{{cite web |title=Maternal mortality ratio per 100,000 live births by WHO region, 1990–2008 |publisher=World Health Organization |url=http://gamapserver.who.int/gho/static_graphs/MDG5_MM_trends.png}}</ref>{{sfn|UN|2015}}
===Maternal mortality—a sentinel event=== In a September 2016 ACOG/SMFM consensus, published concurrently in the journal ''Obstetrics & Gynecology'' and by the [[American College of Obstetricians and Gynecologists]] (ACOG), they noted that while they did not yet have a "single, comprehensive definition of severe maternal morbidity" (SMM), the rate of SMM is increasing in the United States as is maternal mortality. Both are "associated with a high rate of preventability."<ref name="ACOG_SMFM_2016">{{cite journal |vauthors=Kilpatrick SK, Ecker JL |title=Severe maternal morbidity: screening and review |journal=American Journal of Obstetrics and Gynecology |volume=215 |issue=3 |pages=B17-22 |date=September 2016 |pmid=27560600 |doi=10.1016/j.ajog.2016.07.050 |doi-access=free |url=http://www.ajog.org/article/S0002-9378(16)30523-3/pdf}}</ref><ref name="Obstet_Gynecol_2016">{{cite journal |title=Obstetric Care Consensus No 5 Summary: Severe Maternal Morbidity: Screening And Review |journal=Obstetrics and Gynecology |volume=128 |issue=3 |pages=670–1 |date=September 2016 |pmid=27548549 |doi=10.1097/AOG.0000000000001635 |s2cid=7481677}}</ref>
The U.S. [[Joint Commission on Accreditation of Healthcare Organizations]] calls [[maternal mortality]] a "[[sentinel event]]", and uses it to assess the quality of a health care system.{{sfn|Joint Commission|2010}}
Maternal mortality data is said to be an important indicator of overall health system quality because pregnant women survive in sanitary, safe, well-staffed and stocked facilities. If new mothers are thriving, it indicates that the health care system is doing its job. If not, problems likely exist.<ref>{{cite journal |last=Garret |first=Laurie |name-list-style=vanc |title=The Challenge of Global Health |journal=Foreign Affairs |volume=86 |issue=1 |pages=14–38 |date=January–February 2007 |url=http://www.fao.org/WAICENT/faoInfo/Agricult/againfo/home/en/news_archive/doc/2010_GARRETT_Challenge_of_Global_Health.pdf |archive-date=23 September 2020 |access-date=13 January 2013 |archive-url=https://web.archive.org/web/20200923152223/http://www.fao.org/WAICENT/faoInfo/Agricult/againfo/home/en/news_archive/doc/2010_GARRETT_Challenge_of_Global_Health.pdf |url-status=dead }}{{rp|33}}</ref>
According to Garret, increasing maternal survival, along with life expectancy, is an important goal for the world health community, as they show that other health issues are also improving. If these areas improve, disease-specific improvements are also better able to positively impact populations.{{sfn|Garret|2007|p=32}}
===MMR in low and lower-middle income countries=== ==== Statistics ==== Maternal mortality rates are extremely high worldwide. However, most women who die during or after pregnancy live in low and lower-middle income countries. Specifically, in 2017, 94% of all maternal deaths occurred in low and lower-middle income countries. The MMR in low-income countries was 462 in 2017 signifying that 462 mothers died during childbirth for every 100,000 live births.<ref name=":8">{{Cite web |title=Maternal mortality |url=https://www.who.int/news-room/fact-sheets/detail/maternal-mortality |access-date=2022-04-08 |website=www.who.int |language=en}}</ref> In many low and lower-middle income countries complications of pregnancy and childbirth are the leading causes of death among women of reproductive age. According to the World Health Organization, in its World Health Report 2005, poor maternal conditions account for the fourth leading cause of death for women worldwide, after HIV/AIDS, malaria, and tuberculosis.<ref name=":9">{{cite web |author=World Health Organization |year=2005 |title=World Health Report 2005: make every mother and child count |url=https://www.who.int/whr/2005/en/index.html |archive-url=https://web.archive.org/web/20050409001725/http://www.who.int/whr/2005/en/index.html |archive-date=9 April 2005 |publisher=WHO |location=Geneva}}</ref> In low-income countries, most maternal deaths and injuries during pregnancy and labor are due to preventative issues that have been largely eradicated in higher income countries including postpartum hemorrhaging, hypertensive disease, and maternal infections.<ref name=":10">{{Cite journal |last1=Goldenberg |first1=Robert L. |last2=McClure |first2=Elizabeth M. |last3=Saleem |first3=Sarah |date=2018-06-22 |title=Improving pregnancy outcomes in low- and middle-income countries |journal=Reproductive Health |volume=15 |issue=Suppl 1 |page=88 |doi=10.1186/s12978-018-0524-5 |issn=1742-4755 |pmc=6019988 |pmid=29945628 |doi-access=free}}</ref> For example, postpartum hemorrhaging is the leading cause of maternal death globally; however, 99% of postpartum hemorrhages occur in low and lower-middle income countries.<ref>{{cite journal | doi=10.1186/s12884-020-03303-1 | doi-access=free | title=Maternal multimorbidity during pregnancy and after childbirth in women in low- and middle-income countries: A systematic literature review | date=2020 | last1=McCauley | first1=Mary | last2=Zafar | first2=Shamsa | last3=Van Den Broek | first3=Nynke | journal=BMC Pregnancy and Childbirth | volume=20 | issue=1 | page=637 | pmid=33081734 | pmc=7574312 }}</ref>
==== Decline in MMR over time ==== The MMR is extremely high in low-income countries; however, it is necessary to acknowledge the reduction in MMR that has occurred over the past two decades. The MMR has drastically declined in low-income countries since 2010.{{cn|date=April 2024|reason=previous reference source was unrelated to this article.}} In low and lower-middle income countries, the average decline rate of the MMR is about 2.9% since 2000.{{cn|date=April 2024|reason=previous reference source was unrelated to this article.}} This improvement was caused by lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of "skilled birth attendants"—people with training in basic and emergency obstetric care—to help women give birth. Despite this immense progress, there is still lots of work that must be done in order for low-income countries to meet the goal of the WHO organization of an MMR of less than 130 by 2030. Looking forward, the MMR in low and lower-income countries must continue to decline through improving access to skilled birth attendants to perform cesarean sections and other necessary procedures, increased access to family planning, and increased access to hospital facilities.<ref name=":10"/>
===MMR in high-income countries=== Until the early 20th century developed and developing countries had similar rates of maternal mortality.<ref name="strategies_1998"/> Since most maternal deaths and injuries are preventable,<ref name="ACOG_SMFM_2016"/> they have been largely eradicated in the developed world.
In developed countries, Black (non-Latina) women have higher maternal mortality rates than White (non-Latina) women. According to the [[New York City Department of Health and Mental Hygiene|New York City Department of Health and Mental Hygiene - Bureau of Maternal, Infant and Reproductive Health]], it was found that from 2008 to 2012, Black (non-Latina) women have a pregnancy-related mortality rate twelve times higher than White (non-Latina) women.<ref>{{cite web | title = New York City, 2008–2012: Severe Maternal Morbidity | url = https://www1.nyc.gov/assets/doh/downloads/pdf/data/maternal-morbidity-report-08-12.pdf | work = New York City Department of Health and Mental Hygiene | date = 2016 | location = New York, NY | access-date = 14 May 2020 | archive-date = 11 August 2023 | archive-url = https://web.archive.org/web/20230811121016/https://www.nyc.gov/assets/doh/downloads/pdf/data/maternal-morbidity-report-08-12.pdf | url-status = dead }}</ref> The U.S. has the "highest rate of maternal mortality in the industrialized world."<ref name="ProPublica_Ellison_2017"/> It is also estimated that 50% of the deaths are from preventable causes.<ref>{{cite journal | vauthors = Troiano NH, Witcher PM | title = Maternal Mortality and Morbidity in the United States: Classification, Causes, Preventability, and Critical Care Obstetric Implications | journal = The Journal of Perinatal & Neonatal Nursing | volume = 32 | issue = 3 | pages = 222–231 | date = 2018 | pmid = 30036304 | doi = 10.1097/jpn.0000000000000349 | s2cid = 51712622 }}</ref> It was found that Black women were experiencing higher rates of maternal mortality from cardiomyopathy, complications from hypertension, and hemorrhage.<ref name=":14">{{Cite journal|title=Reducing Disparities in Severe Maternal Morbidity and Mortality|first=Elizabeth A.|last=Howell|date=2 June 2018|journal=Clinical Obstetrics and Gynecology|volume=61|issue=2|pages=387–399|doi=10.1097/GRF.0000000000000349|pmid=29346121|pmc=5915910}}</ref> Black women were also found to be at an increased risk for experiencing preeclampsia, abrupt placentae, placenta prevue, and postpartum hemorrhage when compared to white women.<ref name=":14"/> Even though these obstetric complications could also occur in white women, black women were more likely to experience fatality and adverse outcomes from these complications.
Since 2016, [[ProPublica]] and [[NPR]] investigated factors that led to the increase in maternal mortality in the United States. They reported that the "rate of life-threatening complications for new mothers in the U.S. has more than doubled in two decades due to pre-existing conditions, medical errors and unequal access to care."<ref name="ProPublica_Ellison_2017">{{cite news |url=https://www.propublica.org/article/severe-complications-for-women-during-childbirth-are-skyrocketing-and-could-often-be-prevented |title=Severe Complications for Women During Childbirth Are Skyrocketing — and Could Often Be Prevented |series=Lost mothers |date=22 December 2017 |access-date=22 December 2017 |publisher=[[ProPublica]] |first1=Katherine |last1=Ellison |first2=Nina |last2=Martin | name-list-style = vanc }}</ref> According to the United States [[Centers for Disease Control and Prevention]] (CDC), c. 4 million women who give birth in the US annually, over 50,000 a year, experience "dangerous and even life-threatening complications."<ref name="ProPublica_Ellison_2017"/> Of those 700 to 900 die every year "related to pregnancy and childbirth." A "pervasive problem" is the rapidly increasing rate of "severe maternal morbidity" (SMM), which does not yet have a "single, comprehensive definition".<ref name="ACOG_SMFM_2016"/> The U.S healthcare system is in need of great improvement to reduce the rates of maternal mortality. With the shortage of primary care providers, including access to midwives and obstetricians, pregnant women are experiencing a delay in receiving prenatal care.<ref name=":15">{{Cite journal|title=Social and Structural Determinants of Health Inequities in Maternal Health|first1=Joia|last1=Crear-Perry|first2=Rosaly|last2=Correa-de-Araujo|first3=Tamara|last3=Lewis Johnson|first4=Monica R.|last4=McLemore|first5=Elizabeth|last5=Neilson|first6=Maeve|last6=Wallace|date=1 February 2021|journal=Journal of Women's Health|volume=30|issue=2|pages=230–235|doi=10.1089/jwh.2020.8882|pmid=33181043|pmc=8020519}}</ref> This is of even greater concern for pregnant women that have chronic conditions prior to pregnancy, such as hypertension or diabetes, that need to have their pregnancies closely monitored.<ref name=":15"/>
According to a report by the CDC, in 1993 the rate of SMM rose from 49.5 to 144 "per 10,000 delivery hospitalizations" in 2014, an increase of almost 200 percent. Blood transfusions also increased during the same period with "from 24.5 in 1993 to 122.3 in 2014 and are considered to be the major driver of the increase in SMM. After excluding blood transfusions, the rate of SMM increased by about 20% over time, from 28.6 in 1993 to 35.0 in 2014."<ref name="CDC_SMM_2017">{{cite news|title=Severe Maternal Morbidity in the United States|url=https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html|agency=[[Centers for Disease Control and Prevention]]|date=27 November 2017 |access-date=21 December 2017 |location=Atlanta, Georgia }} Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, U.S. Department of Health & Human Services.</ref>
== The Sustainable Development Goals and maternal mortality == In [[Sustainable Development Goal 3|SDG 3]], countries set a target to accelerate the decline of maternal mortality by 2030, specifically to: reduce "the global MMR to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average".
==Proposed improvements== The WHO estimates that the cost to provide basic family planning for both maternal and neonatal health care to women in developing countries is US$8 per person a year.<ref name="Ali">{{cite journal |last1=Ali |first1=Moazzam |last2=Bellows |first2=Ben |title=Family Planning Financing |journal=Family Planning Evidence Brief |date=2018 |url=https://apps.who.int/iris/bitstream/handle/10665/255863/WHO-RHR-18.26-eng.pdf?ua=1 |access-date=22 October 2020 |publisher=World Health Organization |location=Geneva, Switzerland}}</ref> Many non-profit organizations have programs educating the public and gaining access to emergency obstetric care for mothers in developing countries. The United Nations Population Fund (UNPFA) recently began its Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA), focusing on providing quality healthcare to mothers. One of the programs within CARMMA is Sierra Leone providing free healthcare to mothers and children. This initiative has widespread support from African leaders and was started in conjunction with the African Union Health Ministers.<ref>{{Cite web|url=http://www.unfpa.org/public/site/global/lang/en/pid/5479|archive-url=https://web.archive.org/web/20101020211023/http://www.unfpa.org/public/site/global/lang/en/pid/5479|title=UNFPA: "Creating Good CARMMA for African Mothers"|archive-date=20 October 2010}}</ref>
Improving maternal health was the fifth of the United Nations' eight [[Millennium Development Goals]] (MDGs), targeting a reduction in the number of women dying during pregnancy and childbirth by three quarters by 2015, notably by increasing the usage of skilled birth attendants, contraception and family planning.<ref>{{cite journal |last1=Kimani |first1=Mary |title=Investing in the Health of Africa's Mothers |journal=Africa Renewal |date=2008 |volume=21 |issue=4 |pages=8–11 |doi=10.18356/f4e27408-en |url=https://www.un.org/africarenewal/sites/www.un.org.africarenewal/files/africa-renewal-21no4-english.pdf |access-date=22 October 2020}}</ref> The current decline of maternal deaths is only half of what is necessary to achieve this goal, and in several regions such as Sub-Saharan Africa the maternal mortality rate is actually increasing. However, one country that may meet their MDG 5 is Nepal, which has it appears reduced its maternal mortality by more than 50% since the early 1990s.<ref>Jakob Engel, Jonathan Glennie, Shiva Raj Adhikari, Sanju Wagle Bhattarai, Devi Prasad Prasai and Fiona Samuels, [http://www.developmentprogress.org/sites/developmentprogress.org/files/case-study-summary/development_progress_-_nepal_case_study_summary.pdf Nepal's Story, Understanding improvements in maternal health] {{Webarchive|url=https://web.archive.org/web/20160304075000/http://www.developmentprogress.org/sites/developmentprogress.org/files/case-study-summary/development_progress_-_nepal_case_study_summary.pdf |date=4 March 2016 }}, March 2014</ref> As the 2015 deadline for the MDG's approaches, an understanding of the policy developments leading to the inclusion of maternal health within the MDG's is essential for future advocacy efforts.<ref>{{cite book | vauthors = Boese K, Dogra N, Hosseinpour S, Kobylianskii A, Vakeesan V | chapter = Chapter 1 – Analyzing the Inclusion of MDG 5, Improving Maternal Health, among the UN's Millennium Development Goals. | veditors = Hoffman SJ, Ali M | chapter-url = https://www.mcmasterhealthforum.org/docs/default-source/Misc/student-voices-6_2013-06-26.pdf?sfvrsn=2 | title = Student Voices 6: Political Analyses of Five Global Health Decisions | location = Hamilton, Canada | publisher = McMaster Health Forum | year = 2013 | archive-date = 27 May 2016 | access-date = 22 July 2015 | archive-url = https://web.archive.org/web/20160527014856/https://www.mcmasterhealthforum.org/docs/default-source/Misc/student-voices-6_2013-06-26.pdf?sfvrsn=2 | url-status = dead }}</ref>{{Update-inline|date=July 2025}}
According to the [[UNFPA]], maternal deaths would be reduced by about two-thirds, from 287,000 to 105,000, if needs for modern family planning and maternal and new-born health care were met.<ref name="Determinants" /> Therefore, investing in family planning and improved maternal health care brings many benefits including reduced risks of complications and improvement in health for mothers and their children. Education is also critical with research showing "that women with no education were nearly three times more likely to die during pregnancy and childbirth than women who had finished secondary school."<ref name="Determinants" /> Evidence shows that women who are better educated tend to have healthier children. Education would also improve employment opportunities for women which results in improving their status, contributing to family savings, reducing poverty and contributing to economic growth. All of these invests bring significant benefits and effects not only for women and girls but also their children, families, communities and their country.
Developed countries had rates of maternal mortality similar to those of developing countries until the early twentieth century, therefore several lessons can be learned from the west. During the nineteenth century Sweden had high levels of maternal mortality, and there was a strong support within the country to reduce mortality rate to fewer than 300 per 100,000 live births. The Swedish government began public health initiatives to train enough midwives to attend all births. This approach was also later used by Norway, Denmark, and the Netherlands who also experienced similar successes.<ref name="strategies_1998">{{cite journal | vauthors = De Brouwere V, Tonglet R, Van Lerberghe W | title = Strategies for reducing maternal mortality in developing countries: what can we learn from the history of the industrialized West? | journal = Tropical Medicine & International Health | volume = 3 | issue = 10 | pages = 771–82 | date = October 1998 | pmid = 9809910 | doi = 10.1046/j.1365-3156.1998.00310.x | s2cid = 2886632 | doi-access = free }}</ref>
Increasing contraceptive usage and family planning also improves maternal health through reduction in numbers of higher risk pregnancies and by lowering the [[Birth spacing|inter-pregnancy interval]].<ref>{{cite journal | vauthors = Wendt A, Gibbs CM, Peters S, Hogue CJ | title = Impact of increasing inter-pregnancy interval on maternal and infant health | journal = Paediatric and Perinatal Epidemiology | volume = 26 Suppl 1 | pages = 239–58 | date = July 2012 | issue = 1 | pmid = 22742614 | pmc = 4562277 | doi = 10.1111/j.1365-3016.2012.01285.x }}</ref><ref>{{cite journal | vauthors = Ganatra B, Faundes A | title = Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 36 | pages = 145–155 | date = October 2016 | pmid = 27640082 | doi = 10.1016/j.bpobgyn.2016.07.008 }}</ref><ref>{{Cite report|url=https://www.who.int/entity/maternal_child_adolescent/documents/birth_spacing.pdf|title=Report of a technical consultation on birth spacing |date=2005|publisher=WHO|access-date=2018-04-03}}</ref> In Nepal a strong emphasis was placed on providing family planning to rural regions and it was shown to be effective.<ref name="NYT20100413">{{cite news |last=Grady |first=Denise |name-list-style=vanc |date=13 April 2010 |title=Maternal Deaths Decline Sharply Across the Globe |newspaper=New York Times |url=https://www.nytimes.com/2010/04/14/health/14births.html}}</ref> Madagascar saw a dramatic increase in contraceptive use after instituting a nationwide family planning program, the rate of contraceptive use increased from 5.1% in 1992 to 29% in 2008.<ref>{{cite web |author=World Health Organization and UNICEF |title=Countdown to 2015 decade report (2000–2010): taking stock of maternal, newborn and child survival |year=2010 |location=Geneva |publisher=WHO and UNICEF |url=http://whqlibdoc.who.int/publications/2010/9789241599573_eng.pdf }}</ref>
Family planning has been reported to be a significant factor in maternal health. Governments should invest in their national healthcare to ensure that all women are aware of birth control methods. The government, through the ministry of health, should liaise with the private healthcare as well as the public healthcare division to ensure that women are educated and encouraged to use the right family planning method. The government should invest in this operation as when the rate of underage, as well as unplanned pregnancies, are reduced the healthcare cost stand a chance to drop by up to 8%. Healthcare will, therefore, be in a position to handle the other women who give birth. This will result in an improvement in maternal health.<ref>{{Cite report |last1=Bloom |first1=David |last2=Kuhn |first2=Michael |last3=Prettner |first3=Klaus |date=July 2015 |title=The Contribution of Female Health to Economic Development |location=Cambridge, MA |doi=10.3386/w21411 |doi-access=free |publisher=National Bureau of Economic Research |id=Working Paper No. 21411}}</ref>
Four elements are essential to maternal death prevention.{{Says who|date=July 2025}} First, prenatal care. It is recommended{{By whom|date=July 2025}} that expectant mothers receive at least four antenatal visits to check and monitor the health of mother and fetus. Second, skilled birth attendance with emergency backup such as doctors, nurses and midwives who have the skills to manage normal deliveries and recognize the onset of complications. Third, emergency obstetric care to address the major causes of maternal death which are hemorrhage, sepsis, unsafe abortion, hypertensive disorders and obstructed labour. Lastly, postnatal care which is the six weeks following delivery. During this time bleeding, sepsis and hypertensive disorders can occur and new-borns are extremely vulnerable in the immediate aftermath of birth. Therefore, follow-up visits by a health worker is assess the health of both mother and child in the postnatal period is strongly recommended.<ref name="Checkups">{{cite web |title=Your Postpartum Checkups |website=March of Dimes |date=2018 |url=https://www.marchofdimes.org/pregnancy/your-postpartum-checkups.aspx |access-date=22 October 2020}}</ref> Digital health technologies are increasingly being used to support maternal care worldwide. Online pregnancy communities and telehealth programs have been shown to improve access to information and reduce feelings of isolation among expectant mothers. These digital tools can also help healthcare providers monitor pregnancies remotely, improving continuity of care for women in underserved or rural regions. According to the World Health Organization, “Digital health, or the use of digital technologies for health, has become a salient field of practice for employing routine and innovative forms of information and communications technology (ICT) to address health needs.”<ref>{{cite book |url=https://www.who.int/publications/i/item/9789241550505 |title=WHO guideline: Recommendations on Digital Interventions for Health System Strengthening |publisher=World Health Organization |year=2019 |location=Geneva |access-date=October 7, 2025}}</ref> A 2023 review found that digital technology-enabled health interventions, such as mobile applications and virtual education programs, improve engagement and health outcomes for expectant mothers.<ref>{{cite journal |last=Moise |first=I. K. |year=2023 |title=Lessons from Digital Technology-Enabled Health Interventions |url=https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05454-3 |journal=BMC Pregnancy and Childbirth |access-date=October 7, 2025}}</ref>
== See also == * [[Brain health and pollution]] * [[Complications of pregnancy]] * [[Maternal Health Task Force]] * [[Maternal health in Rwanda]] * [[Global health]] * [[Global Strategy for Women's and Children's Health]] * [[Birth attendant]]s * [[Sex education]] * [[Reproductive health]] * [[Reproductive Health Supplies Coalition]] * [[Women's health]] * [[Black maternal mortality in the United States|Black Maternal Mortality in the United States]] * [[Postpartum bleeding|Postpartum Bleeding]]
== References == {{reflist}}
== Bibliography == {{refbegin}} * {{cite journal|last1=Joint Commission|author-link=Joint Commission|title=Preventing maternal death|journal=Sentinel Event Alert|date=26 January 2010|issue=44|url=https://www.jointcommission.org/assets/1/6/SEA_44_Maternal_Death_4_26_16.pdf|archive-date=10 May 2017|access-date=31 July 2016|archive-url=https://web.archive.org/web/20170510181600/https://www.jointcommission.org/assets/1/6/SEA_44_Maternal_Death_4_26_16.pdf|url-status=dead}} * {{cite journal|title=Maternal survival (5 articles)|journal=[[The Lancet]]|date=September–October 2006|url=http://www.thelancet.com/series/maternal-survival|volume=368}} * {{cite journal | vauthors = Rosenfield A, Maine D, Freedman L | title = Meeting MDG-5: an impossible dream? | journal = Lancet | volume = 368 | issue = 9542 | pages = 1133–5 | date = September 2006 | pmid = 17011925 | doi = 10.1016/S0140-6736(06)69386-0 | s2cid = 12109602 | ref = {{harvid|Rosenfield et al|2006}} }} * {{cite book|last=UN|author-link=United Nations|title=The Millennium Development Goals Report 2015|date=2015|publisher=[[United Nations]]|location=New York|url=https://www.un.org/millenniumgoals/2015_MDG_Report/pdf/MDG%202015%20rev%20(July%201).pdf}} {{refend}}
== External links == * {{cite web |title=5. Improve maternal health |work=Millennium Development Goals |publisher=UNICEF |url=http://www.unicef.org/mdg/maternal.html |ref={{harvid|UNICEF Maternal Health}}}} * {{cite web|title=Maternal Health|publisher=World Health Organization|url=https://www.who.int/health-topics/maternal-health|ref={{harvid|WHO Maternal Health}}}}
{{Women's health|state=collapsed}} {{Public health}} {{Reproductive health}} {{Authority control}}
{{DEFAULTSORT:Maternal Health}} [[Category:Maternal health| ]] [[Category:Sexual health]] [[Category:Obstetrics]] [[Category:Women's health]] [[Category:Midwifery]]