Association Between Water and Sanitation Environment and Maternal Mortality

This paper, published in the journal Tropical Medicine and International Health, presents the findings of a systematic review assessing whether the lack of water or sanitation facilities can be associated with maternal mortality. The authors included 14 published articles in the final review once all papers identified during the literature search were screened.

A meta-analysis was conducted of the 14 identified articles, that is, statistical methods were used to combine the results of the individual studies. These are the results of the meta-analysis:

Evidence of an association between poor sanitation and maternal mortality:

• Four out of five ecological studies (population level) that looked at sanitation indicated that poor sanitation was linked to high maternal mortality.
• Two individual level studies indicated that women living in households with poor sanitation were over three times more likely to die of maternal mortality than women living in households with better sanitation .

Evidence of an association between poor water environment and maternal mortality:

• Four out of six ecological studies (population level) found an association between poor water environment and higher maternal mortality.
• One individual level study found a significant association between poor water environment and maternal mortality.

Evidence of an association between water and sanitation combined and maternal mortality:

• Two ecological studies (population level) and one facility-level showed an association between both water and sanitation environment and maternal mortality. 

Overall, the results demonstrate that there is evidence of an association between sanitation and maternal mortality, as well as water and maternal mortality.  The authors end by cautioning readers that the conclusions made are based on a small number of studies, but that there are plausible pathways through which these associations may take place.

Read the Evidence for Action Facts and Figures on Water, Sanitation and Hygiene here