Visualizing maternal morbidity

Editor’s note: Humanosphere’s regular global health visual-info specialist, Katie Leach-Kemon, is taking some time off to celebrate the fact that she and husband Mark are new parents to a healthy baby boy. During her maternity leave, Katie’s colleagues at IHME will be contributing reports. 

By Amy VanderZanden 

Maternal mortality is a popular subject in global health, but what about the many women who suffer disability as a result of pregnancy and childbirth?

While pregnancy, childbirth and the postpartum period are not remotely easy for women in the United States, compared to some parts of the world, it could be considered a fairly straightforward life event.

Maternal morbidity includes side effects like diabetes and excessive weight gain, but also such potentially life-threatening issues as sepsis, eclampsia, maternal hypertension, hemorrhage, uterine prolapse, infertility or any other of a long list of health outcomes. Maternal morbidity can be physical or psychological, and can result from direct or indirect causes which can have a lifetime impact on a woman’s health.

Uterine prolapse, for example, is most commonly caused by difficulty at childbirth. It can have drastic effects on a woman’s quality of life, impacting her ability to sit or walk; it can lead to back and abdominal pain, and make going to the bathroom difficult. Without surgery, prolapse can be permanently disabling.

Despite the fact that the majority of women globally have finished bearing children by the age of 45 or 49, the snapshot from the data visualization tool below shows that women can continue to suffer health problems from their childbearing years for the rest of their lives.

Years lived with disabilities due to maternal disorders, by age, in 2010

MaternalMorbidity1

Notes: Source: Global Burden of Disease Study 2010. To explore the data visualization online, go to http://ihmeuw.org/2jl3.

While maternal mortality measures are considered to be critical estimates of countries’ progress in improving maternal health, maternal deaths are thought to be the tip of the iceberg on which maternal morbidity is based. Researchers estimate that for every woman who dies of pregnancy-related causes, as many as 20 to 30 others experience acute or chronic morbidity, often with permanent effects that can diminish their physical, mental, or sexual health.

According to IHME’s Global Burden of Disease data, the global burden of years lived with disabilities from maternal disorders was nearly 1.8 million in 2010, an increase of nearly 30 percent since 1990.

When we look further into Global Burden of Disease data on the impact of these causes, it becomes immediately clear that the vast majority of those suffering from ongoing disabilities related to maternal complications are in developing countries.

Years lived with disabilities due to maternal disorders in developed and developing countries, in 2010

MaternalMorbidity2

Notes: Source: Global Burden of Disease Study 2010. To explore the data visualization online, go to http://ihmeuw.org/2jl6.

While China and India, the world’s most populous countries, make up the bulk of the total number of women with long-term effects of maternal disorders, when we adjust for differences in population sizes across countries we see that women suffer long term from complications of pregnancy and childbirth nearly everywhere within the developing world – and most acutely in sub-Saharan Africa.

Burden of maternal disorders per 100,000, 2010

MaternalMorbidity3

MaternalMorbidity4

Notes: Source: Global Burden of Disease Study 2010. To explore the data visualization online, go to http://ihmeuw.org/2jl7.

Maternal morbidity is often the result of preventable causes – including inadequate transportation to medical facilities and lack of education around sexual and reproductive health, as well as availability of skilled clinical care workers, and the economic realities of people living in impoverished communities.

Much work is being done to decrease preventable maternal mortality worldwide, as part of the priorities of the Millennium Development Goals. But there is little discussion about maternal morbidity as a separate priority at the global policy level. The WHO post-Millennium Development Goals consensus statement on ending maternal mortality mentions maternal morbidity briefly, as a strategic objective to contribute to the goal of ending preventable maternal mortality.

Deaths and years living with disabilities due to maternal disorders, from 1990 to 2010

MaternalMorbidity5

Notes: Source: Global Burden of Disease Study 2010. To explore the data visualization online, go to http://ihmeuw.org/2jl9.

Globally, maternal mortality rates have seen a steady decline since the 1990s. Looking at the above time plot, however, we see that morbidity from maternal disorders has scarcely budged during the same period. While progress on improved maternal health outcomes is encouraging, it is clear that there is still much more to be done to make pregnancy and childbearing a safe and healthy reproductive decision for all women.

Amy VanderZandenAmy VanderZanden is a communications data specialist at the University of Washington’s Institute for Health Metrics and Evaluation (IHME). 

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  • Glad to see uterine prolapse was mentioned in article; although seldom life threatening, it is always life altering for women whether developed or developing zone. The difficulties accessing health care in developing zones truly compounds this cryptic health concern. Nepal is the only country in the international arena with a government initiative to raise awareness, unsettling considering pelvic organ prolapse (POP) has been on medical record for over 4000 years, childbirth is the leading causal factor, and estimates indicate POP may impact up to half the female population (there is no accurate statistical capture at this point). Until the shroud is lifted from this extremely common health concern, women will continue to suffer in silence.