Morbidity and mortality in pregnancy: laying the groundwork for safe motherhood.

The Safe Motherhood Initiative is a global effort to reduce deaths and illnesses among women and infants. Despite the relatively low maternal mortality rate in the United States, ensuring safe motherhood is still critical. For several reasons, it is important to study maternal mortality and morbidity. First, the pregnancy-related mortality ratio has not declined; second, evidence suggests that at least half of pregnancy-related deaths may be preventable through changes in patient, provider, or system factors; and third, mortality rates are disproportionately high among certain racial and ethnic groups. In addition, deaths are only the tip of the iceberg: maternal morbidity also represents a huge burden of disease for women and their families. Broadening the research focus and prevention efforts to include the study of maternal morbidity, especially near-miss morbidity-life-threatening morbidity-can strengthen the study of maternal death. This paper presents an overview of maternal mortality and morbidity including incidence and etiology, issues and challenges for measurement, and issues of preventability. We also address specific strategies for change for health care providers, federal and state health agencies, and the public health community.