Groups Compared to Women beyond the Teen Years.’’ Ameri-
can Journal of Obstetrics and Gynecology 171 (1994):184–187.
Kenneth J. Moise Jr.MATERNAL HEALTH
A comprehensive definition of maternal, or repro-
ductive, health was one of many important contribu-
tions of the landmark United Nations International
Conference on Population and Development (ICPD)
held in September 1994 in Cairo, Egypt. The ICPD
definition stated that ‘‘Reproductive health is a state
of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity, in
all matters relating to the reproductive system and to
its functions and processes. Reproductive health
therefore implies that people are able to have a satis-
fying and safe sex life and that they have the capabili-
ty to reproduce and the freedom to decide if, when
and how often to do so.’’
Measuring Maternal Health
The most common indicator of maternal health
used internationally is maternal mortality, usually
measured as the ratio of deaths to women while preg-
nant or within forty-two days of termination of preg-
nancy per 100,000 live births. Deaths are usually
included only if the cause is related to or aggravated
by the pregnancy or its management. Maternal mor-
tality is a rare event in the United States. However,
the 1998 ratio of 7.1 deaths per 100,000 live births
was higher than the ratio in many other industrialized
countries. No progress was observed in the United
States in the 1990s, and disturbing differences persist
in the incidence of maternal death among ethnic
groups. African-American women have three times
the risk of maternal mortality compared with white
women, and the risk of death for Latinas or Hispanic
women also appears to be significantly higher than
the risk for white women.
In order to prevent maternal mortality and elimi-
nate disparities, researchers must determine the fun-
damental causes of pregnancy-related deaths.
Defining and measuring maternal morbidity is also
critical because illnesses and complications of preg-
nancy are far more common than maternal deaths.
While it is not easy to obtain an accurate count of all
of the deaths that might be precipitated by pregnancy
or childbirth, the legal requirement for registering
deaths and filing death certificates assures a fairly
high level of completeness. Measuring the morbidity
that accompanies women’s reproductive lives is much
more difficult.
The U.S. Department of Health and Human Ser-
vices, Office of Disease Prevention and Health Pro-
motion, developed an initiative called Healthy
People, which establishes new health objectives for
the nation every ten years. The overall goals of
Healthy People 2010 are to increase longevity and
quality of life and to eliminate health disparities in
the population. One aim is to reduce maternal mor-
tality by more than 50 percent, to an overall ratio of
3.3 deaths per 100,000 live births by the year 2010.
A similar objective for maternal morbidity cannot
be set because severe complications throughout preg-
nancy are too difficult to measure reliably with exist-
ing data. Instead, Healthy People 2010 focused its
attention on problems that occur during labor and
delivery. Most women in the U.S. deliver their babies
in hospitals with trained providers who record any
complications to the mother and the newborn. In
1998, hospital discharge data indicated that women
experienced complications of labor and delivery in
nearly one-third (31.2) of every 100 deliveries. The
objective for improving this rate is a target of twenty-
four complications per 100 deliveries by the year
2010.
Two other maternal health outcomes were target-
ed for improvement in the Healthy People 2010 ob-
jectives, even though data that is gathered will not
facilitate adequate monitoring of these events. The
first is ectopic pregnancies, sometimes called tubal
pregnancies, that result from the implantation and
development of a fertilized egg in a woman’s fallopi-
an tubes or elsewhere outside the uterus. This condi-
tion, which can pose extreme danger to women and
sometimes causes death if not detected and treated in
a timely fashion, appears to be on the rise in the U.S.
The second concern is postpartum complications, in-
cluding depression as well as physical problems such
as hemorrhage and infection.
Since reproductive health, according to the ICPD
definition, encompasses positive aspects beyond the
absence of disease or disability, many other indicators
would be required to monitor maternal wellness. For
example, women’s psychological health, quality of
life, level of satisfaction in intimate relationships, and
overall physical condition would need to be mea-
sured. Indicators that track threats to women’s repro-
ductive health, such as domestic violence, toxic
environmental exposures, and hazards in the work-
place, should also be taken into account. Accessibility
and quality of gynecology, family planning, abortion,
preconception, prenatal delivery, and postpartum
services are important issues to monitor. Since most
women spend many more years raising children than
they do bearing children, maternal well-being should
encompass the experience of childrearing as well as
women’s development throughout the life cycle.
Older women are often ignored in the realm of repro-248 MATERNAL HEALTH