Deaths Attributable to Childbearing in Matlab, Bangladesh: Indirect Causes of Maternal Mortality Questioned

This study aims to clarify the contribution of indirect causes to maternal mortality by analyzing the problem from an epidemiological perspective using population-based data from Matlab Bangladesh for the period 1976-93. The time spent during pregnancy and the puerperium was considered a transitory exposure period for womens lives and death rates were calculated for women aged 15-44 years old while exposed and not exposed. During or shortly after pregnancy death rates from all causes are more than twice as high as outside this period. Once direct obstetric causes and injuries are excluded the death rates among women while exposed are substantially lower than the death rates among women while not exposed. Furthermore this study was able to highlight the complexity of the mere concept of indirect causes of maternal mortality and clearly illustrates the inherent difficulties in singling out deaths attributable to pregnancy and the puerperium. Deaths from accidents suicides or homicides are not usually considered due to the pregnancy yet they may be indirectly related to the pregnancy. Moreover even if the changing physiology during pregnancy is associated with an aggravation of certain diseases the corresponding excess risk cannot be quantified because those diseases are likely to reduce female fertility be it for physiologic or behavioral reasons.