This category can also be referred to as maternal mortality. Maternal conditions are those affecting women because they are pregnant, or when giving birth or shortly after and are due to the birth. They include haemorrhage (bleeding), infection, eclampsia, ectopic pregnancy, high blood pressure, difficulties giving birth (obstructed labour) and conditions due to abortions and miscarriages.

In much of the country rates are very low with two fifths of neighbourhoods having SMRs below 25. Twenty-one neighbourhoods have SMRs of 400 and above, with a worrying cluster of the three Birmingham neighbourhoods of Handsworth, Ladywood East and Hodge Hill West.

Maternal mortality is now a rare cause of death in the developed world. In Britain it has accounted for about 50 deaths per year over the last two decades. All maternal deaths in the UK are investigated by the Confidential Inquiry into Maternal and Child Health (CEMACH).

However, in other parts of the world this is still a prominent cause of death for women. The countries with the highest rates of death due to pregnancy and childbirth are Sierra Leone, Angola and Afghanistan (see www.worldmapper.org).

In the ICD-10 time period a quarter of deaths in this category are indirect, that is, they are pregnancy-related deaths of patients with a pre-existing or newly developed health problem.

Indirect causes are conditions such as malaria, anaemia and HIV/AIDS that complicate pregnancy or are aggravated by it.

The maternal mortality ratio (MMR) is the ratio of the number of maternal deaths per 100,000 live births. It is used as a measure of the quality of a health care system as high rates of maternal mortality reflect poor nutrition and health care. The decline in maternal deaths in rich countries over the past century has been due to improved infection control, the use of Caesarean section, fluid management and blood transfusion, and improved pre-natal care.