New research reveals alarming geographic disparities in pregnancy-related deaths, with some districts showing nearly three times the mortality rate of others.
A comprehensive study published in Scientific Reports has uncovered devastating spatial disparities in perinatal mortality across Lesotho, with the national rate standing at 46.1 deaths per 1,000 births, significantly higher than regional and global averages.
The research, which analysed data from the 2023/24 Lesotho Demographic and Health Survey, found that perinatal mortality is “significantly clustered,” with hotspots concentrated in the western parts of Leribe, Berea, and Maseru, as well as northern Botha-Bothe District.
“The overall prevalence of perinatal mortality in Lesotho was 46.1 per 1000 (95 percent CI: 35, 53), which varies from district to district, with the highest prevalence shown in Botha-Bothe (74.24 per 1000), whereas the lowest was in the Berea district (25.97 per 1000),” the authors reported.
The study paints a grim picture of pregnancy outcomes in the small Southern African nation, where approximately 60,000 babies are born annually, about 200 per day, including roughly three stillbirths and six neonatal deaths daily.
“Perinatal mortality is a major public health challenge in many developing countries and has profound social, economic, and health implications for families and broader society,” the researchers wrote.
The mortality rate exceeds that of Ethiopia (33 per 1,000) and Nigeria (42 per 1,000), and stands in stark contrast to developed nations like the Netherlands (4.6/1,000) and North America (7/1,000).
Dr. Kassaw Chekole Adane, the lead author from Wollo University in Ethiopia, and colleagues identified several modifiable risk factors with strong spatial associations: advanced maternal age (35-49), cigarette smoking, history of terminated pregnancy, childbearing before age 18, and male household headship.
The study found that older mothers face significantly elevated risks, particularly in Leribe, Berea, Maseru, and Mafeteng districts. The researchers explained that “as maternal age increases, the risk of adverse pregnancy conditions such as pregnancy-induced hypertension, antepartum hemorrhage, cesarean delivery, preterm delivery, low birth weight, and premature rupture of membranes also rises.”
Cigarette smoking emerged as a powerful predictor, strongly increasing perinatal mortality risk in Botha-Bothe, Leribe, and Berea districts. “Smoking cigarettes leads to low birth weight, preterm delivery, spontaneous abortion, stillbirth, fetal death, and sudden infant death syndrome,” the study notes.
The analysis revealed that mothers who gave birth before age 18 face significantly higher risks, with the strongest effects observed in Leribe, Berea, Maseru, Mafeteng, and Mohale-Hoek districts. “Adolescent mothers are more likely to have premature and low birth weight babies, which are an important cause or contributor to perinatal mortality,” the authors explained.
Perhaps unexpectedly, the study found that male-headed households showed a negative association with perinatal mortality in some districts, a finding the researchers suggest may reflect cultural barriers to healthcare access.
“In many societies, male household heads were the primary decision makers regarding the use of contraceptives, emergency obstetric services, antenatal care, and delivery care, which results in a delay seeking care due to a need to obtain permission and funding from him,” the study states.
The researchers employed sophisticated Multi-scale Geographically Weighted Regression (MGWR) analysis, which explained 54.73 percent of the spatial variation in perinatal mortality, a method allowing each risk factor to operate at its own geographic scale.
“The presence of multiple bandwidths in MGWR allowed the model to account for an optimal number of neighbours to estimate each parameter, which allowed better estimation of the correlation of the independent and dependent variables,” the authors noted.
Lead investigator Adane’s team emphasises that spatial clustering requires geographically focused solutions rather than blanket national approaches.
“Due to the spatial clustering of perinatal deaths, targeted, geographically focused interventions are crucial, especially in hotspot areas like Leribe, Berea, Maseru, and the northern parts of Botha-Bothe District, to lower perinatal mortality and promote equitable health outcomes,” the researchers concluded.
The study offers specific recommendations for policymakers. Prioritise genetic counseling, improve access to tertiary care for delivery, and raise awareness of risks, especially for older mothers in Maseru, Mafeteng, Berea, Mohale-Hoek, and Leribe districts.
The authors urge “governments and development partners” to implement taxation and behaviour change communication to prevent smoking during pregnancy, improve access to sexual education and contraception to prevent adolescent pregnancy, and reduce unsafe terminations.
“Empowering women economically and socially, along with involving male partners in maternal health education, are crucial for areas where the predictors of the MGWR coefficient show a strong association with reducing perinatal mortality rates,” the study recommends.
The researchers acknowledge several limitations, including geographic coordinates shifted by up to 5 kilometers in rural areas and 2 kilometers in urban areas to protect privacy, which may affect precise location identification.
“Some important possible predictors that could affect perinatal mortality, such as fetal growth, maternal anemia, obstetric complications like breech delivery, and birth asphyxia, were not included in the dataset,” the authors noted.
Despite these constraints, the study provides compelling evidence that Lesotho’s perinatal mortality crisis demands urgent, geographically tailored action, a matter of life and death for hundreds of families each year.
Summary
- “In many societies, male household heads were the primary decision makers regarding the use of contraceptives, emergency obstetric services, antenatal care, and delivery care, which results in a delay seeking care due to a need to obtain permission and funding from him,” the study states.
- “The presence of multiple bandwidths in MGWR allowed the model to account for an optimal number of neighbours to estimate each parameter, which allowed better estimation of the correlation of the independent and dependent variables,” the authors noted.
- “Due to the spatial clustering of perinatal deaths, targeted, geographically focused interventions are crucial, especially in hotspot areas like Leribe, Berea, Maseru, and the northern parts of Botha-Bothe District, to lower perinatal mortality and promote equitable health outcomes,” the researchers concluded.
Ntsoaki Motaung is an award-winning health journalist from Lesotho, specializing in community health stories with a focus on sexual and reproductive health and rights, as well as HIV. She has contributed to platforms like “Be in the KNOW,” highlighting issues such as the exclusion of people with disabilities from HIV prevention efforts in Lesotho.
In addition to her journalism, Ntsoaki serves as the Country Coordinator for the Regional Media Action Plan Support Network (REMAPSEN). She is also a 2023 CPHIA Journalism Fellow.
