Overview: Making Pregnancy Safer


Every time a woman conceives a child she is embarking on a very dangerous phase of her life. While pregnancy is a time of increased risk for all women, the risk of death and disability is considerably greater for women living in the African Region.

This has been so for many decades and, while the rates of maternal death have been reduced by almost half, from 960 per 100 000 live births in 1990 to 510 per 100 000 live births in 2013, women are still dying too often because they have been denied the skilled care and support needed to diagnose and treat lethal complications of pregnancy.

The major conditions killing women in pregnancy and childbirth have changed over the past few decades. Previously, infection and anaemia were the major killers, but these, while still important, are no longer the leading causes of death. In 2010, haemorrhage (34%) and hypertensive disease of pregnancy (19%) were given as causes for more than half of maternal deaths in sub-Saharan Africa. Both these conditions need a skilled attendant to diagnose the problem, and access to a well-equipped health centre to manage it effectively.

Severe bleeding after birth can kill a healthy woman within 2 hours if she is unattended, but even those in hospitals with skilled carers will die if blood and blood products are not available. Managing hypertensive disease of pregnancy requires knowledge and experience to detect signs of deterioration and a supply of appropriate medication to avert the convulsions, internal organ haemorrhage and ultimate death that follows.

Access to skilled care tends to be determined by wealth and geography. Surveys performed from 2000 to 2011 found big differences in access to a skilled attendant during birth for the richest and poorest women. The widest gaps (more than 70% difference) between the poorest and richest were in Guinea, Madagascar and Nigeria, and the smallest gap, of around 20%, was in Sao Tome and Principe.

Levels of antenatal care have increased in most other regions of the world, so that it is now the norm for pregnant women to have at least four antenatal care visits and to have a skilled person – a nurse, midwife or medical practitioner – care for them throughout childbirth. However, this is not the norm in many parts of the Region, particularly in remote rural areas or among the poorest groups. Only 12 countries reported antenatal care coverage with four visits at levels of 68–78%. In other words, even in the best-performing countries, one third of pregnant women are not receiving adequate care.

Lack of education, living in rural areas and lack of financial resources are all factors associated with poor antenatal care – although this varies between countries. The widest gaps between coverage among the non-educated and the highest educated were seen in Chad, Ethiopia, Mali, Niger and Nigeria (e.g. in Nigeria, coverage was 31% among the non-educated and 88% among the highest educated). However, in several countries there was very little difference in coverage between the wealth quintiles. For instance, in Rwanda coverage was 97% and 99% in the poorest and richest quintiles, respectively.

Vaccination rates against tetanus ‒ a common cause of neonatal deaths, especially where women give birth in unhygienic conditions without a skilled birth attendant ‒ has been low in the Region. Only one third of countries have achieved protection levels of at least 80% among women of childbearing age.


The reduction in maternal mortality seen in the Region has been the result of improvement of services in some countries where deliberate investments have been made to address challenges such as financial and geographical inaccessibility to quality maternity services. Removal of user fees for maternity services, which has been introduced in 24 countries; institutionalization of maternity waiting homes in some countries, including Eritrea; and introduction of results- and performance-based financing in Rwanda have all contributed to the reduction of maternal mortality in the past decade.

Increased financing from domestic resources and from the Global Fund has helped countries to provide antiretroviral medicines to more pregnant women living with HIV. The percentage of pregnant woman with HIV being treated with antiretroviral therapy (ART) has gone up from 34% in 2009 to 63% in 2012 and is above 80% in 12 countries. This has led to a decline in AIDS-related maternal deaths between 2008 and 2010 in high-burden HIV countries such as Botswana, Swaziland, Zambia and Zimbabwe.

The Making Pregnancy Safer Programme comprises four components:

  1. Skilled Attendance
  2. Newborn health
  3. Prevention of mother-to-child transmission of HIV (PMCT)
  4. Community Involvement.

For more information:

Dr Triphonie Nkurunziza
Telephone: +47 241 39132
E-mail: Este endereço de e-mail está protegido contra spambots. Você deve habilitar o JavaScript para visualizá-lo.

Related Links:

  1. WHO Headquaters - Making Pregnancy Safer