Reproductive mortality in Lusaka, Zambia, 1982-1983

In this study, age- and parity-specific birth data were used to estimate maternal mortality rates for 1982-83 at University Teaching Hospital in Lusaka, Zambia. Overall, 60 maternal deaths occurred during pregnancy or within 42 days after pregnancy termination, and four pregnancy-related deaths occurred more than 42 days after pregnancy termination. Nine of the 60 maternal deaths were caused by induced abortion, one by spontaneous abortion, twelve by hypertensive disease of pregnancy, ten by hemorrhage, nine by puerperal sepsis, and four by ectopic pregnancy. Of the 12 women who died from nonobstetric causes, one committed suicide because of an unwanted pregnancy. Women aged 35 years and older or who had had four previous pregnancies had a higher risk of dying than other women, especially by hemorrhage. The chief risk factors included not using an effective method of contraception, using an unsafe means to terminate unintended pregnancies, lack of prenatal care, refusing a blood transfusion (for religious reasons), and inadequately treating hypertensive disease of pregnancy. Overall, 31 of 60 women who died lacked adequate or appropriate medical care and 19 failed to obtain available health care. Medical management problems appeared to occur more frequently during the night-time medical shift.