TEHRAN – Iran plans to decrease maternal mortality rate of 20 to 8.7 per 100,000 live births by the next 12 years, a decrease of about 55 percent, Nasrin Changizi, head of the maternal health department at the Ministry of Health has said.

According to an article titled “Maternal Mortality in Iran: Realization of the Millennium Development Goals” which was published in Journal of Mazandaran University of Medical Sciences in June 2017, Iran with an average annual reduction of 6.4 percent since 1990-2015 and a total reduction of 80 percent in maternal mortality during the past 25 years is among the nine countries which have fully achieved the fifth Millennium Development Goal.

“The department’s main plan is maternal health, as well as ensuring health of infants since their first two hours of life, so, in addition to hospital treatment, out-of-hospital and postpartum care services, are provided to mothers and infants for up to six weeks after childbirth,” Changizi said, ISNA reported on Wednesday.

“We plan to bring the death rate of mothers, which is currently around 20 per 100,000 live births, to 8.7 per 100,000 people within next 12 years,” she said, adding, the plan must be set on recognizing the most effective preventable measures which cause maternal mortality such as postpartum hemorrhage and pregnancy blood pressure.

Since the beginning of this year (March 21), we have focused on provinces where the death rate among mothers occurred mostly due to bleeding after birth, so that we prepared plans on reducing such deaths which will be implemented by the next year (March 2019- March 2020), she further explained.

She then expressed hope that with the implementation of the plans in the next two to three years, we will witness a downward trend in preventable causes of maternal mortality.

“Our other target is to identify mothers at risk in early stages, in this regard, coordinated measures have been taken and operational plans have been implemented over the past three years to reduce pregnancy and delivery complications,” she further noted.

Moreover, to create the perfect environment for childbirth, maternal health department prepared plans which are provided in form of the maternity health service package, he highlighted.

She also added that presence of fathers in delivery rooms is also allowed, so all of the measures will cause a strong emotional connection between mother and infant. 

“There are some 2000 birthing beds in the country,” Changizi stated.

Promotion of natural childbirth in Iran

She went on to say that with natural childbirth promotion package in the National Health System Reform Plan, a decrease in cesarean section rate happened, although there are mothers facing special conditions which prevent them from vaginal delivery. 

Since the Iranian calendar year of 1384 (March 2005- March 2006), we have been planning to promote vaginal delivery, she said, adding, in this regard, training courses on preparation for vaginal delivery have been set up aiming at informing mothers the differences between the normal delivery and the caesarean section. 

Elsewhere in her remarks, she noted that in addition to side effects of delivery methods, issues such as pelvic floor care, miscarriages, psychological counselling on elimination of vaginal delivery fear are among the subject discussed in the courses.

She went on to explain that in the Iranian calendar year of 1387 (March 2008- March 2009), the aforesaid training courses were expanded, while so far, after a couple of years, only one fifth of pregnant women attend the courses. We are trying to promote the courses, especially in the private sector. 

Also, in the public sector, conditions must be provided to oblige pregnant women to attend the courses so that two-thirds of the population receiving the state-run hospital services will also participate, Changizi added.

Caesarean sections rate

According to the World Health Organization (WHO), since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10-15 percent. Since then, caesarean sections have become increasingly common in both developed and developing countries. When medically necessary, a caesarean section can effectively prevent maternal and newborn mortality. Two new HRP studies show that when caesarean section rates rise towards 10 percent across a population, the number of maternal and newborn deaths decreases. When the rate goes above 10 percent, there is no evidence that mortality rates improve.

Different factors such as the pregnant women’s awareness regarding vaginal delivery, lack of awareness about the complications of cesarean section, fear of vaginal delivery, being encouraged by physician and the reduced role of midwives in training, have led to increased willingness of mothers for cesarean section. 

In recent years, according to the ministry of health data, the rate of cesarean section in Iran has increased by 40 to 60% which is three times more than global standards. Although, according to WHO guidelines, the rate of cesarean section should be 5–15 percent. 

Hence, a program called the Healthcare Evolution Plan has been implemented in Iran since May 4, 2014 in order to fulfill the goals of the WHO including health, fairness in financial contribution and meeting the non-treatment expectations of the public. Iran was the second highest country in the world to have caesarian section at the start of the project, while it was expected that by the end of 2014 the rate of cesarean section would be reduced by as much as 10 percent. 

Maternal mortality causes, prevalence in world

Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. The major complications that account for nearly 75% of all maternal deaths are severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery and unsafe abortion.

As WHO estimated, maternal mortality is unacceptably high, as about 830 women die from pregnancy- or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303,000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented.

In sub-Saharan Africa, a number of countries halved their levels of maternal mortality since 1990. In other regions, including Asia and North Africa, even greater headway was made. Between 1990 and 2015, the global maternal mortality ratio (the number of maternal deaths per 100 000 live births) declined by only 2.3% per year between 1990 and 2015. However, increased rates of accelerated decline in maternal mortality were observed from 2000 onwards. In some countries, annual declines in maternal mortality between 2000–2010 were above 5.5%.

The high number of maternal deaths in some areas of the world reflects inequities in access to health services, and highlights the gap between rich and poor. Almost all maternal deaths (99%) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia. More than half of maternal deaths occur in fragile and humanitarian settings.

The maternal mortality ratio in developing countries in 2015 is 239 per 100 000 live births versus 12 per 100 000 live births in developed countries. There are large disparities between countries, but also within countries, and between women with high and low income and those women living in rural versus urban areas, as women in developing countries have, on average, many more pregnancies than women in developed countries.

The risk of maternal mortality is highest for adolescent girls under 15 years old and complications in pregnancy and childbirth is a leading cause of death among adolescent girls in developing countries.

FB/MQ/MG