Abstract

Introduction: Maternal mortality is a pressing global health issue, reflecting the well-being of women during pregnancy, childbirth, and the postpartum period. Despite healthcare advancements, it remains unresolved, with the most severe impact in developing countries where approximately 95% of maternal deaths occurred in 2020. Even in Europe, known for high healthcare standards, maternal mortality persists, emphasising the complexity of the problem. This tragedy results from various causes, including severe haemorrhages, pre-eclampsia, infections, and childbirth complications. These factors intertwine with socioeconomic inequalities and healthcare access challenges. Despite progress in medicine and women’s rights, maternal mortality remains a stark reality, highlighted by its inclusion in the UN’s Sustainable Development Goals.

Aims: This study aims to investigate maternal deaths, causes, age-specific distributions, and the Maternal Mortality Ratio (MMR) evolution over a period spanning two decades (2000-2019). Emphasis was placed on the Central and Western European region to discern patterns, high-risk countries, and the prevalent causes of maternal deaths.

Materials and Methods: Using data from the 2019 Global Burden of Disease (GBD) database by the Institute for Health Metrics and Evaluation (IHME), we extracted information related to maternal mortality, years of life lost (YLLs), the number of deaths within a specific time period (Death), and the maternal mortality ratio (MMR) between 2000 and 2019 in the regions of Central and Western Europe. The analysis focused on women aged 15 to 59 years old.

Results: Our dataset consisted of 480,480 records with 9 distinct attributes. Central and Western Europe displayed variability, with Romania registering the highest maternal death rate (0.1368) and Andorra the lowest (0.0118). Bulgaria and Albania also showed relatively elevated rates. In real figures, Romania, Bulgaria, and North Macedonia ranked top three in maternal deaths per 100,000 live births. When considering years of life lost (YLLs) due to maternal deaths, Romania and Bulgaria were again prominent, while Andorra and San Marino recorded the lowest.

On the causative front, “Maternal disorders” was the primary contributor to maternal deaths with 7,549 deaths. “Other maternal disorders” followed with 3,520 deaths. The leading cause associated with the highest MMR was also “Maternal disorders” with a mean MMR of 57.67 per 100,000 live births.

Age-specific evaluations revealed the age bracket 30-34 years as having the highest number of maternal deaths. In MMR terms, the 50-54 years group emerged as the most affected with an MMR of 54.98.

A longitudinal analysis over the 20-year window showed a 69% reduction in MMR across all countries, with a decline from 18.18 in 2000 to 5.64 by 2019. Similarly, maternal deaths saw a steady decrease from 1,023 in 2000 to 561 in 2019.

Conclusion: The period from 2000 to 2019 witnessed significant progress in maternal health across Central and Western Europe, with a notable reduction in MMR. Despite these advancements, disparities exist among countries, age groups, and the causes of maternal deaths. The data underscores the imperative need for targeted interventions, especially in high-risk countries, to further improve maternal health outcomes.

Introduction

According to the World Health Organization (WHO), maternal mortality is defined as “The annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy”. It remains a critical global health concern, reflecting the overall well-being of women during pregnancy, childbirth, and the postpartum period. Despite significant advancements in healthcare, maternal mortality rates continue to be an unsolved problem, being the worst in developing world (Antsaklis & Antsaklis, 2023). According to the World Health Organisation (2023), approximately 300,000 women die as a result of pregnancy and childbirth, of which about 95% of maternal deaths (in 2020) occurred in developing countries.

While Europe is generally known for its high standards of healthcare and social services, it is not immune to maternal mortality challenges. The investigation unfolds in a time span characterized by significant advancements in medical technology, increased access to healthcare services, and evolving socio-cultural dynamics (Li & Carayon, 2021). Despite these developments, maternal mortality has remained a public health concern, highlighting the complexity of the issue (Girum & Wasie, 2017).

Maternal mortality is a tragedy that can be attributed to a series of complex and interrelated causes. Among the main causes are severe haemorrhages, which often result from complications during childbirth or caesarean section. In addition, pre-eclampsia and eclampsia, conditions involving high blood pressure during pregnancy, pose a serious threat to maternal health. Infections (sepsis and untreated urinary tract infections) and unsafe abortion can also lead to fatal consequences. Complications during childbirth, such as umbilical cord prolapse or shoulder dystocia, can result in critical medical emergencies. (Say et al., 2014; World Health Organization, 2023) These are just some of the many facets of the underlying causes of maternal mortality, which often reflect not only medical problems, but also socioeconomic inequalities and challenges of access to quality healthcare.

Furthermore, despite remarkable advances in medicine and the evolution of women’s rights over the last few decades, maternal mortality persists as a threatening reality that cries out for attention and immediate action. Reducing maternal mortality is one of the United Nations Sustainable Development Goals (SDG 3) (United Nation, n.d.), reflecting the global recognition of the importance of this problem and the need to do more to protect women’s lives during pregnancy and childbirth. More specifically, the United Nations’ goal is “By 2030, reduce the global maternal mortality ratio to less than 70 per 100000 live births”, so, it is important to analyse the numbers and the causes of maternal mortality.

This research paper delves into the intricate web of factors influencing maternal mortality in the Central and Western Europe. In this comprehensive analysis, we delve into the causes and numbers behind maternal mortality in Central and Western European region, seeking to unravel the hidden facets of this critical issue and provide a foundation for informed decision-making aimed at safeguarding the health and lives of mothers in the region. European region over the two decades from 2000 to 2019.

Our analysis draws upon comprehensive data from the Global Burden of Disease 2019 (Institute for Health Metrics and Evaluation, 2023), shedding light on the multifaceted causes, trends, and disparities in maternal mortality within this geographic area.

Thus, this paper is structured as follows: section 2 presents a detailed focus on the objectives that the paper intends to answer; section 3 describes the method used to reach the objectives; section 4 presents the results that were reached; and, in the end, section 5 presents the discussion, and the conclusions; and, in the end, section 6, shows the limitations, and future work related to the field under analysis.

Methods

Results

LDiscussion

The dataset spanning Central and Western Europe provides a comprehensive overview of maternal mortality in the region.

There are notable differences in maternal death rates and YLLs across countries. Romania and Bulgaria consistently reported higher rates, while Andorra, Iceland, and Monaco showed lower values. These variations might be due to differences in healthcare systems, socio-economic conditions, or even data collection and reporting methodologies among these countries.

In terms of causative factors for maternal deaths, the prominence of “Maternal disorders” as a leading cause may suggest potential inconsistencies in coding classifications. While it’s possible that clinical and healthcare factors contributed to these trends, the consistency of certain categories might hint at issues related to data quality or coding practices. Therefore, when reviewing these findings, it’s important to approach them with an understanding that there could be challenges related to coding classification.

Age-based analysis underscores the complementary nature of the various metrics used in the study. Specifically, while the age bracket 30-34 years exhibited the highest number of deaths, the age group 50-54 years presented the highest MMR, despite having fewer deaths. This emphasizes the importance of considering both absolute death counts and rates relative to live births when interpreting maternal mortality. Given that fecundity rates vary across different age groups, evaluating absolute numbers alone may provide a misleading representation. Understanding both the number of deaths and the MMR in tandem gives a more holistic view of maternal mortality across age demographics, and underscores the need for comprehensive evaluation mechanisms in health studies.

The trend of decreasing maternal deaths and MMR over the past two decades is a positive sign. It could be indicative of improvements in healthcare delivery, policy changes, or other contributing factors. Nevertheless, there remains a consistent presence of maternal mortality, emphasizing the need for ongoing attention and efforts in this area.

Limitations and Future Directions

The majority of causes fall into two very generic groups: “Maternal Disorders” and “Other Maternal Disorders”. These data were sourced from the GBD (Global Burden of Disease). Consequently, we lack detailed information regarding specific causes. This ambiguity might be attributed to variations in how health professionals code these causes or how these are reported between different countries and through the years. As a result, we cannot draw clear conclusions at the level of specific causes. Future research may benefit from incorporating additional sources to gain insights into factors like socio-economic conditions and healthcare quality, which can influence maternal health outcomes.

Conclusion

The period from 2000 to 2019 witnessed significant progress in maternal health across Central and Western Europe, with a notable reduction in MMR. Despite these advancements, disparities exist among countries, age groups, and the causes of maternal deaths. The data underscores the imperative need for targeted interventions, especially in high-risk countries, to further improve maternal health outcomes.

References

• Antsaklis, A., & Antsaklis, P. (2023). What is already done by different societies in reduction of maternal mortality? Are they successful at all? Journal of Perinatal Medicine, 51(2), 233–239. https://doi.org/10.1515/jpm-2022-0408

• Girum, T., & Wasie, A. (2017). Correlates of maternal mortality in developing countries: an ecological study in 82 countries. Maternal Health, Neonatology and Perinatology, 3(1). https://doi.org/10.1186/s40748-017-0059-8

• Institute for Health Metrics and Evaluation. (2023). Global Burden of Disease Study 2019. Li, J., & Carayon, P. (2021). Health Care 4.0: A vision for smart and connected health care. IISE Transactions on Healthcare Systems Engineering, 11(3), 171–180. https://doi.org/10.1080/24725579.2021.1884627

• Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A. B., Daniels, J., Gülmezoglu, A. M., Temmerman, M., & Alkema, L. (2014). Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health, 2(6). https://doi.org/10.1016/S2214-109X(14)70227-X

• United Nation. (n.d.). Ensure healthy lives and promote well-being for all at all ages.

• World Health Organization. (2023). Maternal Mortality.