The World Health Organization (WHO) estimates that 529,000 maternal deaths occur worldwide each year . Reducing mortality related to complications of pregnancy, labor, and delivery continues to be a priority and to receive attention globally. The Lancet series on maternal survival [2-6] is a call to focus attention on the high burden of maternal mortality in the developing world. Additionally, the series provides a critical overview of existing strategies that are most likely to exert an impact. The United Nations' 5 th Millennium Development Goal (MDG) is a call to reduce maternal mortality by 75% between 1990 and 2015, a goal that appears to be more elusive and one that is lagging behind most [7, 8], despite ongoing efforts by the Safe Motherhood Initiative, an effort launched in 1987 to
From: Nutrition and Health: Handbook of Nutrition and Pregnancy Edited by: C.J. Lammi-Keefe, S.C. Couch, E.H. Philipson © Humana Press, Totowa, NJ
reduce maternal morbidity and mortality. There appears to be a consensus on the kind of focused approaches and the necessary tools and strategies known to work to reduce maternal death. Addressing obstetric complications, be it through increasing the availability of skilled attendants or emergency obstetric care or by meeting unmet obstetric need, is a prime focus of the Safe Motherhood Initiative and the Maternal Survival Series steering group . Fully recognizing the urgency and importance of effective intrapartum care  and similar strategies, this chapter examines the evidence for the role of nutrition in contributing to a reduction in maternal mortality in the developing world. The purpose is not to detract attention from ongoing initiatives and partnerships focused on skilled birth attendance, intrapartum, and emergency obstetric care, but to add to these a consideration of specific nutritional interventions with known established efficacies for enhancing maternal health and survival. Poor nutrition is often referred to in the same broad terms as economic development, poverty, low education, and poor access to medical care — factors that are known to be underlying contributors to the burden of maternal mortality and that are likely to take much longer to address. Another well-accepted notion is that it is hard to prevent maternal health risks—because every pregnancy faces a risk. Nonetheless, evidence suggests that some nutritional interventions can reduce the burden of life threatening morbidities that result in maternal death, especially in many underserved settings of the world where health care access is poor and maternal malnutrition is high. This chapter examines such interventions and strategies and provides the biologic basis, rationale, and empirical evidence for the impact of nutrition in ameliorating the risk of maternal mortality in the developing world.
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