Annually, 16 million girls aged between 15 and 19 give birth each year. Ninety percent of the births in developing countries occur in single teens or adolescent marriages. Many of these women have been married off as children and lack the education, money and status to get adequate healthcare services.Complications run rampant in adolescent pregnancies. Children having children will face substantial risk from having small pelvises that can obstruct labour resulting in long labour times, birth injuries and an increased risk of stillborn births. In many countries, the risk of maternal death is twice as high for adolescent mothers. However, maternal mortality rates of any age are unacceptably high throughout the world.  The increased risk of dying from childbirth is directly linked to the increased rates of obesity, diabetes, high blood pressure and inadequate prenatal care. Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth according to the World Health Organization (WHO). Severe bleeding, infections, unsafe abortion and high blood pressure conditions are four of the main killers that cause 70 percent of the deaths. The good news -- the WHO reports that maternal mortality has been cut in half in some of the most difficult areas since 1990.  This dramatic improvement is primarily related to improved access to healthcare services before, during and after childbirth.  Continued advancement, education and policy development is needed to continue to reduce the risk factors associated with maternal deaths. Maternal death risk 1 in 150Maternal health simply refers to the overall health of a woman during pregnancy, childbirth and the postpartum period. More than 136 million women give birth per year and about 20 million of them experience pregnancy-related complications. Who is at greatest risk of pregnancy-related complications? A woman’s risk increases with the number of pregnancies that she has.  Therefore, adolescent girls under the age of 15 have the highest risks of developing complications over a lifetime.  It is important to know that the bleeding after a delivery can kill even a healthy woman if not attended to properly. The risk of death is directly related to the access and availability of proper healthcare services. Generally, access to services is related to the income of the family or individual. Less income generally equates to less access to care and greater risk of death or complications.A woman’s lifetime risk of maternal death – the probability that a 15-year-old woman will eventually die from a maternal health factor – is 1 in 3800 in developed countries, versus 1 in 150 in developing countries. Women who are attended by trained healthcare professionals are rarer than you think. Nearly half of all childbirths in developing countries are not attended to properly. Attended childbirths still pose the risk of complications such as infections if cleanliness and hygiene standards are not strictly adhered to. Currently, about four million infants die within their first month. Improved access to medical care and maternal nutrition could significantly reduce stillbirths, which now number 3.3 million worldwide. There are over 18 million unsafe abortions that are carried out every year that result in over 46,000 deaths. Half of these abortions are considered unsafe. The WHO defines unsafe abortion as a "procedure for terminating a pregnancy that is performed by an individual lacking the necessary skills, or in an environment that does not conform to minimal medical standards, or both.”Reducing risk factorsMaternal mortality is a largely avoidable cause of death. It is estimated that 80 percent of the deaths result from complications during delivery and the immediate post-partum period.  Many of these complications could have been prevented through education and lifestyle intervention techniques. Conditions that result from high blood pressure, heart disease, infections, home violence and increasing rates of HIV/AIDS can be prevented, maintained or reversed through proper intervention.  One of the major factors that fuel maternal death is malaria.  Data shows that up to 11 percent of deaths can be attributed to being bitten by an infected mosquito.  It is very common for women to be bitten and not even know that they are infected.  Low-grade malaria parasite infections can cause significant harm to the unborn child and increase the risk of complications or even death.  Education addresses root causesExperts at the World Health Organization point to education as the primary way of addressing maternal health in many developing countries. Education can address the root causes – poverty, low status of females and lack of access to healthcare services.The education of girls and young women does a lot more than just improving the lives of mothers; it protects children’s health, facilitates healthy families, creates less of a burden on healthcare delivery systems and improves overall society. Midwifery services save livesIt is very important that all births are attended by a skilled health professional.  Prompt management and treatment can make the difference between life and death.A major complication includes severe bleeding after childbirth that is directly linked to high blood pressure throughout the pregnancy into the labor period. Increased rates of bleeding thus give rise to significantly higher rates of life-threatening infections. Severe bleeding associated with anemia can kill a healthy woman within two hours if she is unattended. The primary cause of excessive bleeding is poor clotting factors in the blood. Improved clotting factors can be corrected and managed with adequate nutritional support.  Anemia is the inability to clot blood that can be treated by utilizing vitamin and mineral supplementation that has iron.  If supplementation is not available, rich sources of iron include dark green leafy vegetables, egg yolks, organ meats (liver and kidney), nuts and sprouted beans. A major consideration to be aware of is iron absorption improves with intake of vitamin C rich foods. Vitamin C is found in citrus fruits, a variety of greens and peppers.Sweet potatoes, melons, peaches, pumpkin and other orange, red, yellow and dark green fruits and vegetables are said to enhance many aspects of one’s immune system, thus reducing one’s risk of infection. Infections after childbirth can nearly be eliminated if good hygiene is practiced and if early signs of infection are recognized and treated in a timely manner. To reduce the risk of newborn deaths, experts agree that adequately nourished and appropriately attended to mothers from early pregnancy through the post-delivery period could eliminate three-quarters of deaths. Midwifery services are key to a healthy and safe pregnancy and childbirth. Many maternal and newborn deaths can be prevented if competent midwives assist women before, during and after childbirth. It’s important to be able to refer pregnancy complications to emergency obstetric care as soon as they arise. Many lives can be saved if a midwife attended every birth.Dr Cory Couillard is an international healthcare speaker and columnist. Facebook: Dr Cory CouillardTwitter: DrCoryCouillard