62 The World Health Report 2005 maternal deaths per year worldwide. The truth is that three quarters of these deaths are currently avoided throughout the world: nearly all the"natural "maternal mortality in developed countries, but only two thirds in the South-East Asia and Eastern Medi- terranean Regions and only one third in African countries There are immense variations in death rates in different parts of the world. Maternal deaths are even more inequitably spread than newborn or child deaths. a tiny 1% of maternal deaths occur in the developed world. Maternal mortality ratios range from 830 per 100 000 births in African countries to 24 per 100 000 births in European countries. Of the 20 countries with the highest maternal mortality ratios, 19 are in sub-Saharan Africa. Regional rates mask very large disparities between countries. Re gions with low overall mortality rates, such as the European Region, contain countries with high rates. Within one single country there can be striking differences between subgroups of the population. Rural populations suffer higher mortality than urban dwellers, rates can vary widely by ethnicity or by wealth status, and remote areas bear a heavy Maternal deaths are deaths from pregnancy-related complications occurring through out pregnancy, labour, childbirth and in the postpartum period (up to the 42nd day after the birth). Such deaths often occur suddenly and unpredictably. Between 11% and 17% of maternal deaths happen during childbirth itself and between 50% and 71% in the postpartum period(4-8). The fact that a high level of risk is concentrated during childbirth itself, and that many postpartum deaths are also a result of what hap- pened during birth, focuses attention on the hours and sometimes days that are spent in labour and giving birth, the critical hours when a joyful event can suddenly turn into an unforeseen crisis. The postpartum period- despite its heavy toll of deaths-is often neglected (4, 9). Within this pe Figure 4.1 Causes of maternal death riod, the first week is the most prone to risk. About 45%of postpartum maternal deaths occur during the first 24 hours Severe bleeding and more than two thirds during the first Indirect causes week(4 The global toll of postpartum maternal deaths is accompanied by the great and often overlooked number of early newborn deaths and stillbirths. Maternal deaths result from a wide range of indirect and direct causes. Other direct causes represent 20% of the global total. They are caused by diseases (pre-existing or concurrent) that are not complications of pregnancy, but complicate pregnancy Infections or are aggravated by it. These include malaria, anaemia. HiviaiDs and cardio vascular disease. Their role in maternal mortality varies from country to country, according to the epidemiological context obstructed and the health systems effectiveness in The lion s share of maternal deaths Total is more than 100% due to rounding is attributable to direct causes. Direct62 The World Health Report 2005 maternal deaths per year worldwide. The truth is that three quarters of these deaths are currently avoided throughout the world: nearly all the “natural” maternal mortality in developed countries, but only two thirds in the South-East Asia and Eastern Medi￾terranean Regions and only one third in African countries. There are immense variations in death rates in different parts of the world. Maternal deaths are even more inequitably spread than newborn or child deaths. A tiny 1% of maternal deaths occur in the developed world. Maternal mortality ratios range from 830 per 100 000 births in African countries to 24 per 100 000 births in European countries. Of the 20 countries with the highest maternal mortality ratios, 19 are in sub-Saharan Africa. Regional rates mask very large disparities between countries. Re￾gions with low overall mortality rates, such as the European Region, contain countries with high rates. Within one single country there can be striking differences between subgroups of the population. Rural populations suffer higher mortality than urban dwellers, rates can vary widely by ethnicity or by wealth status, and remote areas bear a heavy burden of deaths. Maternal deaths are deaths from pregnancy-related complications occurring through￾out pregnancy, labour, childbirth and in the postpartum period (up to the 42nd day after the birth). Such deaths often occur suddenly and unpredictably. Between 11% and 17% of maternal deaths happen during childbirth itself and between 50% and 71% in the postpartum period (4–8 ). The fact that a high level of risk is concentrated during childbirth itself, and that many postpartum deaths are also a result of what hap￾pened during birth, focuses attention on the hours and sometimes days that are spent in labour and giving birth, the critical hours when a joyful event can suddenly turn into an unforeseen crisis. The postpartum period – despite its heavy toll of deaths – is often neglected (4, 9). Within this pe￾riod, the first week is the most prone to risk. About 45% of postpartum maternal deaths occur during the first 24 hours, and more than two thirds during the first week (4). The global toll of postpartum maternal deaths is accompanied by the great and often overlooked number of early newborn deaths and stillbirths. Maternal deaths result from a wide range of indirect and direct causes. Maternal deaths due to indirect causes represent 20% of the global total. They are caused by diseases (pre-existing or concurrent) that are not complications of pregnancy, but complicate pregnancy or are aggravated by it. These include malaria, anaemia, HIV/AIDS and cardio￾vascular disease. Their role in maternal mortality varies from country to country, according to the epidemiological context and the health system’s effectiveness in responding (10). The lion’s share of maternal deaths is attributable to direct causes. Direct Severe bleeding (haemorrhage) 25% Infections 15% Eclampsia 12% Obstructed labour 8% Unsafe abortion 13% Indirect causes 20% Other direct causes 8% a Total is more than 100% due to rounding. Figure 4.1 Causes of maternal deatha