Maternal mortality: Lessons of the millenium development goals, a way forward

The death of a female patient during pregnancy or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, due any cause related to or aggravated by the occurance pregnancy or its management, but not from accidental or incidental causes is called maternal mortality [1]. The latest estimated maternal mortality ratio in Nigeria is 576/100,000 live births [2] which is certainly an underestimation. Vital statistics in a low resource setting such as Nigeria are often incomplete or do not exist and estimates are often based on hospital data which may not reflect the maternal risk within communities. In comparison, the maternal mortality ratio in Denmark is 5.3/100,000 live births. The commonest causes of maternal mortality include haemorrhage, unsafe abortions, hypertension in pregnancy, infections and obstructed labor [3]. These are all direct causes of mortality but a variety of other factors contribute to the delay in a pregnant women seeking help in the presence of complications. A three-delay model was presented for the understanding of the factors which could contribute to maternal mortality [4]. These were delay 1the decision to access care, delay 2the transport to a medical facility, and delay 3the receipt of adequate treatment. These factors are interrelated. For example, socioeconomic, cultural factors, religion, financial and educational factors may lead to a delay in taking a decision to access care. On the other hand, institutional factors and lack of personnel, material may reinforce negative stereotypes about care provided in hospitals and lead to a reluctance to access care. Thus, maternal mortality is seen to be due