Ed note. I am pleased to welcome Annie Feighery to the site. Annie is a mother, global health researcher, and social entrepreneur in New York City. Her work focuses on technology, maternal health, and water.

Nigerian American writer Teju Cole tweets death reports from Nigerian newspaper columns in a series he calls Small Fates. Many involve love, sex, or pregnancy. Here are two:

At Ajao Estate, Ifeoma, merely because she was 8 months pregnant, denied Iwachukwu sex. Horny and annoyed, he tried to strangle her (link)

“I killed myself because I was pregnant,” Offorka, 14, wrote in Benin. He gently placed it on his cousin after hacking her to death (link)

While these deaths give us a picture of the expandability of a pregnant woman in much of the world, for the UN, neither of these deaths count in their measurements of maternal mortality. Today, on International Women’s Day, much attention is given to deaths that occur from direct causes of pregnancy and birth, but indirect causes contribute to far more women’s demise and deserve attention.

The 2010 Gates-funded Lancet-published study from the University of Washington that found a significant decline in maternal mortality also served as a policy precedent to further delimit what deaths count in the estimation of global maternal mortality rates (MMR). Notably, the study eliminated mental health-related deaths, despite the fact that mental health is a critical co-morbidity to maternal health. A 2003 study on maternal mortality in England found suicide to be the leading cause of maternal deaths (the rate has since improved), but for the new UN-recognized calculation, these deaths are also not considered in the global maternal mortality rate.

Homicide- and suicide-related maternal deaths are also eliminated from the measure. This is an especially growing concern because of the increase in immolation-related maternal deaths (ritual burning). Afghanistan has recently launched a social marketing campaign to reduce burnings after 22,000 women were treated in less than a year for setting themselves on fire. A study of an Egyptian burn unit found almost a third of its patients could be classified as pregnancy-related suicide attempts with kerosene ignition the leading cause of burn.

As the international community works to achieve progress in benchmarks and goals for maternal health, it is critically important that they consider the real world conditions these women face—which often do not subscribe to clear epidemiologic delimitations of hemorrhage, infection, and sepsis. Most maternal deaths are not counted because of the lack of infrastructure for vital records in impoverished areas, because they are quietly buried behind a house leaving no death certificate behind, or because they never engaged with a medical facility that might make a record of their lives. We should make sure multilateral global health policies are not yet another reason these women’s deaths don’t count.

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