According to UNFPA, there are four essential elements for prevention of<unk> . These include, prenatal care, assistance with birth, access to emergency obstetric care and adequate postnatal care. It is recommended 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<unk>  which are hemorrhage, sepsis, unsafe abortion, hypertensive disorders and obstructed labor. Lastly, postnatal care which is the six weeks following delivery. During this time, bleeding, sepsis and hypertensive disorders can occur, and newborns are extremely vulnerable in the immediate aftermath of birth. Therefore, follow-up visits by a health worker to assess the health of both mother and child in the postnatal period is strongly recommended. Additionally, reliable access to information, compassionate counseling and quality services for the management of any issues that arise from abortions (whether safe or unsafe) can be beneficial in reducing the number of<unk> s. In regions where abortion is legal, abortion practices need to be safe in order to effectively reduce the number of<unk> s related to abortion.<unk>  Surveillance and Response is another strategy that has been used to prevent<unk> . This is one of the interventions proposed to reduce<unk>  mortality where<unk> s are continuously reviewed to learn the causes and factors that led to the<unk> . The information from the reviews is used to make recommendations for action to prevent future similar<unk> s.<unk>  and perinatal<unk>  reviews have been in practice for a long time worldwide, and the World Health Organization (WHO) introduced the<unk>  and Perinatal<unk>  Surveillance and Response (MPDSR) with a guideline in 2013. Studies have shown that acting on recommendations from MPDSR can reduce<unk>  and perinatal mortality by improving quality of care in the community and health facilities. Prenatal Care It was estimated that in 2015, a total of 303,000 women died due to causes related to pregnancy or childbirth. The majority of these were due to severe bleeding, sepsis or infections, eclampsia, obstructed labor, and consequences from unsafe abortions. Most of these causes are either preventable or have highly effective interventions. An important factor that contributes to the<unk>  mortality rate is access and opportunity to receive prenatal care. Women who do not receive prenatal care are between three and four times more likely to die from complications resulting from pregnancy or delivery than those who receive prenatal care. Even in high-resource countries, many women do not receive the appropriate preventative or prenatal care. For example, 25% of women in the United States do not receive the recommended number of prenatal visits. This number increases for women among traditionally marginalized populations—32% of African American women and 41% for American Indian and Alaska Native women do not receive the recommended preventative health services prior to delivery. Medical technologies The decline in<unk> s has been due largely to improved aseptic techniques, better fluid management and quicker access to blood transfusions, and better prenatal care. Technologies have been designed for resource poor settings that have been effective in reducing<unk> s as well. The non-pneumatic anti-shock garment is a low-technology pressure device that decreases blood loss, restores vital signs and helps buy time in delay of women receiving adequate emergency care during obstetric hemorrhage. It has proven to be a valuable resource. Condoms used as uterine tamponades have also been effective in stopping post-partum hemorrhage. Medications and Surgical Management Some<unk> s can be prevented through medication use. Injectable oxytocin can be used to prevent<unk>  due to postpartum bleeding. Additionally, postpartum infections can be treated using antibiotics. In fact, the use of broad-spectrum antibiotics both for the prevention and treatment of<unk>  infection is common in low-income countries.<unk>  due to eclampsia can also be prevented through the use of medications such as magnesium sulfate. Many complications can be managed with procedures and/or surgery if there is access to a qualified surgeon and appropriate facilities and supplies. For example, the contents of the uterus can be cleaned if there is concern for remaining pregnancy tissue or infection. If there is concern for excess bleeding, special ties, stitches or tools (Bakri Balloon) can be placed if there is concern for excess bleeding. Public health In April 2010 Sierra Leone launched free healthcare for pregnant and breastfeeding women. A public health approach to addressing<unk>  mortality includes gathering information on the scope of the problem, identifying key causes, and implementing interventions, both prior to pregnancy and during pregnancy, to combat those causes and prevent<unk>  mortality. Public health has a role to play in the analysis of<unk> . One important aspect in the review of<unk>  and its causes are<unk>  Mortality Review Committees or Boards. The goal of these review committees are to analyze each<unk>  and determine its cause. After this analysis, the information can be combined in order to determine specific interventions that could lead to preventing future<unk> s. These review boards are generally comprehensive in their analysis of<unk> s, examining details that include mental health factors, public transportation, chronic illnesses, and substance use disorders. All of this information can be combined to give a detailed picture of what is causing<unk>  mortality and help to determine recommendations to reduce their impact. Many states within the US are taking<unk>  Mortality Review Committees a step further and are collaborating with various professional organizations to improve quality of perinatal care. These teams of organizations form a "perinatal quality collaborative" (PQC) and include state health departments, the state hospital association and clinical professionals such as doctors and nurses. These PQCs can also involve community health organizations, Medicaid representatives,<unk>  Mortality Review Committees and patient advocacy groups. By involving all of these major players within<unk>  health, the goal is to collaborate and determine opportunities to improve quality of care. Through this collaborative effort, PQCs can aim to make impacts on quality both at the direct patient care level and through larger system devices like policy. It is thought that the institution of PQCs in California was the main contributor to the<unk>  mortality rate decreasing by 50% in the years following. The PQC developed review guides and quality improvement initiatives aimed at the most preventable and prevalent<unk> s: those due to bleeding and high blood pressure. Success has also been observed with PQCs in Illinois and Florida. Several interventions prior to pregnancy have been recommended in efforts to reduce<unk>  mortality. Increasing access to reproductive healthcare services, such as family planning services and safe abortion practices, is recommended in order to prevent unintended pregnancies. Several countries, including India, Brazil, and Mexico, have seen some success in efforts to promote the use of reproductive healthcare services. Other interventions include high quality sex education, which includes pregnancy prevention and sexually transmitted infection (STI) prevention and treatment. By addressing STIs, this not only reduces perinatal infections, but can also help reduce ectopic pregnancy caused by STIs. Adolescents are between two and five times more likely to suffer from<unk>  mortality than a female twenty years or older. Access to reproductive services and sex education could make a large impact, specifically on adolescents, who are generally uneducated in regards to carrying a healthy pregnancy. Education level is a strong predictor of<unk>  health as it gives women the knowledge to seek care when it is needed. Public health efforts can also intervene during pregnancy to improve<unk>  outcomes. Areas for intervention have been identified in access to care, public knowledge, awareness about signs and symptoms of pregnancy complications, and improving relationships between healthcare professionals and expecting mothers. Access to care during pregnancy is a significant issue in the face of<unk>  mortality. "Access" encompasses a wide range of potential difficulties including costs, location of healthcare services, availability of appointments, availability of trained health care workers, transportation services, and cultural or language barriers that could inhibit a woman from receiving proper care. For women carrying a pregnancy to term, access to necessary antenatal (prior to delivery) healthcare visits is crucial to ensuring healthy outcomes. These antenatal visits allow for early recognition and treatment of complications, treatment of infections and the opportunity to educate the expecting mother on how to manage her current pregnancy and the health advantages of spacing pregnancies apart. Access to birth at a facility with a skilled healthcare provider present has been associated with safer deliveries and better outcomes. The two areas bearing the largest burden of<unk>  mortality, Sub-Saharan Africa and South Asia, also had the lowest percentage of births attended by a skilled provider, at just 45% and 41% respectively. Emergency obstetric care is also crucial in preventing<unk>  mortality by offering services like emergency cesarean sections, blood transfusions, antibiotics for infections and assisted vaginal delivery
Maternal death
Stillbirth
Maternal near miss
Fetal-maternal haemorrhage
After-birth abortion
Unsafe abortion
Maternal-fetal conflict
Forced pregnancy