maternal health maternal health maternal health is the health of women during pregnancy, childbirth, and the postpartum period. in most cases, maternal health encompasses the health care dimensions of family planning, preconception, prenatal, and postnatal care in order to ensure a positive and fulfilling experience. in other cases, maternal health can reduce maternal morbidity and mortality. maternal health revolves around the health and wellness of pregnant women, particularly when they are pregnant, at the time they give birth, and during child-raising. who has indicated that even though motherhood has been considered as a fulfilling natural experience that is emotional to the mother, a high percentage of women develop health problems and sometimes even die. because of this, there is a need to invest in the health of women. the investment can be achieved in different ways, among the main ones being subsidizing the healthcare cost, education on maternal health, encouraging effective family planning, and ensuring progressive check up on the health of women with children. maternal morbidity and mortality particularly affects women of color and women living in low and lower-middle income countries. part of a series onwomen's healthsymbol of women's health reproductive and sexual health reproductive health reproductive tract external female genitalia clitoris clitoral hood labia minora labia majora vagina cervix uterus fallopian tube ovary reproductive system disease maternal health pregnancy unintended pregnancy gravidity and parity obstetrics antenatal care adolescent pregnancy complications of pregnancy hyperemesis gravidarum ectopic pregnancy miscarriage obstetrical bleeding gestational diabetes hypertension preeclampsia eclampsia childbirth midwifery preterm birth multiple births oxytocin obstructed labor cesarian section retained placenta obstetrical fistulae vesicovaginal fistula rectovaginal fistula postpartum care maternal deaths perinatal mortality 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health study cartwright inquiry society for women's health research women's health by country women's health in china women's health in ethiopia women's health in india (family planning) birth control in the united states maternal morbidity and mortality who estimates that about 295,000 maternal deaths occurred in 2017. these causes range from severe bleeding to obstructed labour, all of which have highly effective interventions. further, indirect causes of maternal mortality include anemia and malaria. as women have gained access to family planning and skilled birth attendance with backup emergency obstetric care, the global maternal mortality has fallen by about 44 percent, which represented a decline of about 2.3 percent annually over the period from 1990 to 2015. while there has been a decline in worldwide mortality rates much more has to be done. high rates still exist particularly in low and middle income countries (99%). sub-saharan africa accounts for approximately two thirds of these deaths and south asia for about one-fifth of them. one third of the maternal deaths occur in india and nigeria. the effect of a mother's death results in vulnerable families, and their infants, if they survive childbirth, are more likely to die before reaching their second birthday. both maternal mortality (death) and severe maternal morbidity (illness) are "associated with a high rate of preventability." in 2010 the u.s. joint commission on accreditation of healthcare organizations described maternal mortality as a "sentinel event", and uses it to assess the quality of a health care system. subsidizing the cost of healthcare will help improve the health status of women. however, the health status of women should not be generalized with that of the other category of people. countries such as the u.s, u.k, and others have laws where government and non-governmental bodies work to reduce and even eliminate any fee that is directed to pregnant women or women who have health issues that are related to pregnancy. when women deliver their babies in certified healthcare facilities without paying or paying a very small amount of money, they are motivated to use their own money on the diet of the baby, clothing, and other needs. also, when women attend clinics without being charged and are issued with free supplements, their health is maintained, and this reduces the cost that the monetary resources that the government invests in healthcare. in turn, the maternal morbidity rate, together with mortality rates, is lowered. education on various issues related to maternal health is essential to control and improve the healthcare of women. women who have the resources have a low chance of their health status deteriorating because of the knowledge they have. these women are informed to make decisions regarding family planning, the best time to give birth as far as their financial capabilities are concerned, and their nutrition, before, during, and after giving birth. additionally, many approaches involving women, families, and local communities as active stakeholders in interventions and strategies to improve maternal health. gannon (n.p) reports that the maternal rate of mortality reduced by 70% between 1946 and 1953, when women started getting maternal education. the study has recommended that the study should focus on communities that are marginalized and girls who are below the age of 18. when the government manages to reduce unwanted and unplanned pregnancies among these two groups of people, it will become easier to reduce the maternal health issue and the cost associated with it. factors influencing maternal health poverty and access to healthcare according to a unfpa report, social and economic status, culture norms and values, and geographic remoteness all increase maternal mortality, and the risk for maternal death (during pregnancy or childbirth) in sub-saharan africa is 175 times higher than in developed countries, and risk for pregnancy-related illnesses and negative consequences after birth is even higher. poverty, maternal health, and outcomes for the child are all interconnected. women living in poverty-stricken areas are more likely to be obese and engage in unhealthy behaviors such as cigarette smoking and substance use, are less likely to engage in or even have access to legitimate prenatal care, and are at a significantly higher risk for adverse outcomes for both the mother and child. a study conducted in kenya observed that common maternal health problems in poverty-stricken areas include hemorrhaging, anemia, hypertension, malaria, placenta retention, premature labor, prolonged/complicated labor, and pre-eclampsia. prenatal care main article: prenatal care generally, adequate prenatal care encompasses medical care and educational, social, and nutritional services during pregnancy. for example, prenatal care could include serum integrated screening tests for potential chromosomal abnormalities as well as blood pressure measurements, or uterus measurements to assess fetal growth. although there are a variety of reasons women choose not to engage in proper prenatal care, 71% of low-income women in a us national study had difficulties getting access to prenatal care when they sought it out. additionally, immigrants and hispanic women are at higher risk than white or black women for receiving little to no prenatal care, where level of education is also an indicator (since education and race are correlated). adolescents are least likely to receive any prenatal care at all. throughout several studies, women and adolescents ranked inadequate finances and lack of transportation as the most common barriers to receiving proper prenatal care. map of countries by fertility rate (2020), according to the population reference bureau income is strongly correlated with quality of prenatal care. sometimes, proximity to healthcare facilities and access to transportation have significant effects on whether or not women have access to prenatal care. an analysis conducted on maternal healthcare services in mali found that women who lived in rural areas, far away from healthcare facilities were less likely to receive prenatal care than those who lived in urban areas. furthermore, researchers found an even stronger relationship between lack of transportation and prenatal and delivery care. in addition to proximity being a predictor of prenatal care access, materia and colleagues found similar results for proximity and antenatal care in rural ethiopia. also, inadequate and poor quality services contributes in increasing maternal morbidity and mortality. pregestational diabetes pre-existing (pregestational) maternal type 1 or type 2 diabetes is a known factor that increases the risk of adverse outcomes, including pre-term birth, preeclampsia, and congenital birth defects. studies from the united states and australia indicate that the prevalence of pregestational diabetes is around 1% of pregnancies. even healthy pregnancy causes a state of hyperglycemia. as a result, mothers with pregestational diabetes are at an increased risk for hyperglycemia. hiv/aids maternal hiv rates vary around the world, ranging from 1% to 40%, with african and asian countries having the highest rates. whilst maternal hiv infection largely has health implications for the child, especially in countries where poverty is high and education levels are low, having hiv/aids while pregnant can also cause heightened health risks for the mother. a large concern for hiv-positive pregnant women is the risk of contracting tuberculosis (tb) and/or malaria, in developing countries. 28% of maternal deaths are from obstructed labour and indirect causes, meaning diseases that complicate pregnancy or that are complicated by pregnancy (malaria, anemia, hiv/aids, and cardiovascular diseases). maternal weight during pregnancy, women of an average pre-pregnancy weight (bmi 18.5-24.9) should expect to gain between 25–35 pounds (11–16 kg) over the course of the pregnancy. increased rates of hypertension, diabetes, respiratory complications, and infections are prevalent in cases of maternal obesity and can have detrimental effects on pregnancy outcomes. obesity is an extremely strong risk factor for gestational diabetes. research has found that obese mothers who lose weight (at least 10 pounds or 4.5 kg) between pregnancies reduce the risk of gestational diabetes during their next pregnancy, whereas mothers who gain weight actually increase their risk. women who are pregnant should aim to exercise for at least 150 minutes per week, including muscle strengthening exercises. however, it is recommended that pregnant women discuss what exercise they can do safely with their ob/gyn in the early prenatal period. statistics analysis of the pregnancy mortality surveillance system, conducted by the center for disease control and prevention (cdc), indicates significant racial and ethnic disparities in pregnancy related deaths. the pregnancy related mortality ratio (prmr) represents the number of deaths per 100,000 live births resulting from pregnancy or pregnancy related causes. a 2019 report from the cdc shows that the prmrs of black women and indigenous women in the united states are 3-4 times higher than that of white women. white women had a prmr of approximately 13 maternal deaths per 100,000 live births. while black and indigenous women had prmrs of 41 and 30 maternal deaths per 100,000 live births respectively. the majority of these deaths were due to preventable diseases associated with pregnancy such as hypertension. while the fatality rate of these diseases was higher among black and indigenous women, the initial prevalence was generally the same across all races. although lower than that of black and indigenous women, the prmr for asian and pacific islander women was still slightly higher than that of the white women at 13.5. the prmr for hispanic women has shown a decline in recent years. however, state specific reports show that hispanic women still face high rates of maternal morbidity, or health problems that arise from pregnancy