[MDG5 and maternal mortality: disastrous combination of inequalities]

Maternal mortality is the most striking of injustices, the event in which social inequalities combine most disastrously. For women in the least developed countries, the mean lifetime risk of dying from complications related to pregnancy and childbirth is 300 times higher than for women in industrialized countries. In Algeria, the maternal mortality rate (MMR) in 2006 was 92.6 deaths per 100,000 live births, even though 95.3% of births are attended. Maternal deaths account for 10% of all deaths of women aged 15 to 49 years, and the inequalities are blatant: the MMR in Adrar (southern Algeria) was 230 compared to 30 deaths per 100,000 live births in the municipality of Algiers. Overall, 55% of the deaths occur in hospitals, 57.3% of them after transfer. The causes are known, a high proportion of deaths could be avoided with better trained healthcare personnel and birth attendants and early identification of the pregnant women at risk. Our laboratory thus proposes an approach based on information and on the sharing and delegation of skills. General practitioners are the cornerstone of this community approach based on the early detection and management of parturients at risk.