Long-Term Effect of In-Utero Conditions on Maternal Survival Later in Life: Evidence from Sub-Saharan Africa

Alison B. Comfort, Abt Associates

Sub-Saharan African countries have some of the world’s highest rates of maternal mortality. Most research on maternal mortality focuses on factors during pregnancy and delivery. However, consistent with the fetal programming hypothesis, a woman’s maternal survival may also be related to conditions she experienced while in-utero. This study examines this hypothesis in 14 African countries by relating rainfall when a woman was in-utero with her maternal survival later in life. High levels of rainfall, representing better in-utero conditions, decrease the probability of maternal death by 1.6 percentage points (82%). This appears to be mediated through reduced body-mass index, a predictor of pregnancy-induced hypertension. Poor in-utero conditions, identified by low levels of rainfall, also reduce maternal mortality, likely a result of more facility-based deliveries for higher risk pregnancies. The findings suggest that improving conditions for pregnant women will have inter-generational effects, benefiting pregnant women today and improving their daughters’ maternal survival.