CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Maternal mortality remains the leading cause of death and disability for reproductive-age women in resource-poor countries. The impact of a mother’s death on child outcomes is likely severe but has not been well quantified (Oestergaard, et al., 2011). Maternal mortality is a leading cause of death and disability for adult women worldwide, responsible for an estimated 289,000 deaths in 2013 (WHO, 2014). It represents true excess burden of disease since the overwhelming majority of maternal deaths are due to preventable causes; and could be treated with well-understood interventions that have long been available in the global North (Medhin, et al., 2010). Maternal mortality highlights large inequalities between and within countries; the maternal mortality rate in resource-poor countries is 15 times higher than that in wealthy nations, and within countries, the poorest women see the greatest risk of dying during pregnancy or childbirth (Ronsmans and Graham, 2006). Reducing maternal mortality ratios (MMRs) by 75% from 1990 levels was therefore included in the United Nations’ Millennium Development Goals, as integral to reducing global poverty. Less well-characterized, however, are the short- and long-term consequences of maternal deaths on children, families and communities. Often a maternal death can have spillover effects onto child health, via obstetric complications, infant feeding behaviors, and care for orphans (Molla, et al., 2015). It thus is critically important to look beyond MMRs to fully characterize the harm caused by the loss of a mother (Whetten, et al., 2011). There are a number of mechanisms through which a maternal death may affect outcomes for infants and children. The main direct causes of maternal mortality obstetric complications such as eclampsia, sepsis, obstructed labor and hemorrhage can also put neonates at increased risk of death (Kusiako, et al., 2000 Chan, et al., 2013; Vogel, et al., 2014). If the infant survives birth but the mother does not, the resulting lack of nutritional support from breastfeeding leaves the baby vulnerable to malnutrition, which can itself be fatal or may increase the risk of disease or death from infection (Lindblade, et al., 2003; Ronsmans, et al., 2010; Braitstein, et al., 2013).
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