Maternal Death and Health Worker-Oriented Factors


Nowadays, maternal death is still relevant, and an actively studied issue. Despite the decline of maternal death rate by approximately three times from 2010 to 2017, according to statistics of 2021, 810 women die each day by a complication of childbirth (World Health Organization, 2021, May 4). Studies concerned with maternal death highlight different dimensions of this issue, but they are still not comprehensive. The purpose of this paper is to review various sources and to find a gap among them. First of all, the review will highlight researches concerned with specific factors contributing to maternal deaths. Secondly, given the COVID-19 epidemic, many scholars have studied the relationship between maternal deaths and coronavirus, and respective papers will also be taken into account. Finally, this review will cover sources providing solutions and studying their implementation. All data is taken from articles by different authors published in journals linked to medicine and healthcare and from World Health Organization reports.

Factors of maternal death

One of researches focuses on a respective issue in Indonesia; although this study was published in 2019, it does not emphasize the latest data but refers to 2014’s records taken from 11 hospitals (Baharuddin, et al., 2019). As the quantitative analysis shows, in most cases, deaths of women were due to direct obstetric causes (Baharuddin, et al., 2019). The main finding of this study is highlighting health worker-oriented factors as primary causes of maternal death (Baharuddin, et al., 2019). Nevertheless, research is still limited due to retrospective character without referring to the newest data.

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Another case study focuses on the Sub-Saharan’s Africa region; it takes into account 34 countries and also can be regarded as retrospective because it emphasizes data collected between 1990 and 2014. However, the study is mainly concerned with the timing of death, while particular causes can hardly be revealed due to a lack of information regarding insufficiently established registration systems (Merdad & Ali, 2018). The only factor that can be revealed is the presence of skilled birth attendants, which is associated with lower rates in terms of postpartum mortality (Merdad & Ali, 2018). In other words, despite the lack of particular causes’ analysis, shortage of specialized healthcare workers can be regarded as a primary factor of deaths.


An epidemic of COVID-19 has become one of the most significant social phenomena; therefore, scholars study specific medical issues concerning coronavirus. The first article analyzes 9 cases in Iran and claims that, despite the lack of previously documented maternal deaths linked with COVID-19, the latter results in higher mortality (Hantoushzadeh,, 2020). Notably, the authors point out that 7 of 9 diseased pregnant women died, while one of survived is in a critical condition and another has experienced prolonged hospitalization (Hantoushzadeh,, 2020). Moreover, the authors emphasize coronavirus as a primary cause of mortality compared to healthcare worker-oriented factor, which was discussed in a previous section as a basic one (Hantoushzadeh,, 2020).

Another research presents a more systematic review, encompassing analysis of different articles; its results contradict the previous study. Particularly, it applies quantitative methods of analysis, which demonstrate a lack of relationship between COVID-19 and adverse pregnancy outcomes (Juan, et al., 2020). Overall, according to statistics, out of 324 women, there are only seven maternal death cases, and this ratio is much lower than the results shown in the previous study (Juan, et al., 2020). Anyway, authors still regard data used in research as limited and potentially biased (Juan, et al., 2020).

Maternal death surveillance and response (MDSR)

The World Health Organization (WHO) provides a two-level strategy; the first level is concerned with “equitable access to healthcare”, while the next step is to ensure a high-quality healthcare system (World Health Organization, 2021, May 4). Another report considers accountability and responsiveness one of the qualitative healthcare system’s characteristics (World Health Organization, 2021, October 5). For instance, Maternal death surveillance and response (MDSR) is an approach that satisfies these conditions through regular audits and the organization of local committees collecting respective recordings.

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One of the articles studies implementing MDSR in Kenya; the main challenge, as the authors claim, is underreporting. Overall, the article focuses on possible ways to improve the work of MDSR, referring to the establishment of a stable legal framework, institutionalization, advanced data processing, funding (Smith, Ameh, Godia, et al., 2017). However, the article does not consider the effects of MDSR and the relationship between its work and the change of maternal death rate in Kenya.

Another article encompasses the experience of different countries where MDSR is present on one of the stages of implementation. Authors also refer to existing problems with the establishment of MDSR in a broader level and appeal to similar solutions as in the first article (Smith, Ameh, Roos, et al., 2017). Nevertheless, this work also does not take into account the influence of MDSR over the studied issue.


In conclusion, all studies are concerned with maternal death from different points of view. They can be divided into three distinct groups: studying the most frequent causes of maternal death, the COVID-19’s possible influence over it, and a review of possible solutions, mainly it concerns MDSR concept. This literature presents a deep analysis of an issue, but, at the same time, it is limited by different factors, whether it is possibly biased data or bounds of a topic itself.

Therefore, an issue can be studied further in a more comprehensive way, referring to different dimensions highlighted by studies presented above in a complex. For instance, factors contributing to an issue can be analyzed not in terms of case studies, but in a comparative way, given COVID-19 rates in particular countries and level of MDSR implementation. Also, limits of particular articles can be overcome; for instance, studies can emphasize the newest data instead of retrospective research.

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Akhtar, H., Patel, C., Abuelgasim, E., & Harky, A. (2020). COVID-19 (SARS-CoV-2) infection in pregnancy: a systematic review. Gynecologic and Obstetric Investigation, 85(4), 295-306. Web.

Baharuddin, M., Amelia, D., Suhowatsky, S., Kusuma, A., Suhargono, M. H., & Eng, B. (2019). Maternal death reviews: A retrospective case series of 90 hospital‐based maternal deaths in 11 hospitals in Indonesia. International Journal of Gynecology & Obstetrics, 144, 59-64. Web.

Hantoushzadeh, S., Shamshirsaz, A. A., Aleyasin, A., Seferovic, M. D., Aski, S. K., Arian, S. E.,… & Aagaard, K. (2020). Maternal death due to COVID-19. American journal of obstetrics and gynecology, 223(1), 109-e1. Web.

Merdad, L., & Ali, M. M. (2018). Timing of maternal death: levels, trends, and ecological correlates using sibling data from 34 sub-Saharan African countries. PLoS One, 13(1), e0189416. Web.

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Smith, H., Ameh, C., Godia, P., Maua, J., Bartilol, K., Amoth, P.,… & van den Broek, N. (2017). Implementing maternal death surveillance and response in Kenya: incremental progress and lessons learned. Global Health: Science and Practice, 5(3), 345-354. Web.

Smith, H., Ameh, C., Roos, N., Mathai, M., & van den Broek, N. (2017). Implementing maternal death surveillance and response: a review of lessons from country case studies. BMC Pregnancy and Childbirth, 17(1), 1-11. Web.

World Health Organization. (2021). Why we need to focus on quality care for women and newborns. Web.

World Health Organization. (2021). New global targets to prevent maternal deaths. Web.

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