DefinitionsofMM
Clinically and broadly defined, maternal death is death that occurs in consequence of pregnancy. In practice and by modern internationally agreed definition, maternal deaths are deaths occurring during pregnancy or within some established span of time after parturition (see the discussion in Andersson et al.2000}.
Current international definitions use a 42-day time span. Demographic historians have variously used thirty, forty-two, and sixty days (Wrigley et al.1997: 309, n.144).Definitions of MM based on elapsed time since giving birth of course omit pregnancy-related deaths prior to that point (e.g. from eclampsia, miscarriage, abortion, etc.). Selection of different spans may also have different consequences. The risk of mortality is highest at the termination of pregnancy, then declines rapidly.18 A summary of the excellent Swedish data (Wrigley et al. 1997: table 6.28), following Schofield (1986), shows that 29% of maternal deaths after a live or stillbirth occurred on the day of birth (day 0), 19% in days 1—3, and 11% in days 4—6. Ninety-two per cent of these deaths had occurred by thirty days, 96% by forty-two days, and 98% by sixty days. Recalculated as daily risks, all categories show dramatic decline from birth to day 2, then a slower decline out to day 60 (see Figure 11.3). The risk of death following a stillbirth is much higher than that following a live birth (Wrigley et al.1997: 310) and these deaths occur rapidly. Andersson et α∕.(2000) show that having had a previous stillbirth is an important risk factor in subsequent births; thus women with difficulties in parturition are at special risk.19 Illegitimate births are initially the next riskiest, perhaps reflecting an
Figure 11.3 Risk per day of maternal death, by category
inferior physical condition of mothers bearing children out of wedlock, or poor care before, during, and after birthing. Maternal deaths associated with multiple births are the next riskiest-
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