Long-term effect of in utero conditions on maternal survival later in life: evidence from Sub-Saharan Africa

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. I examine this hypothesis in 14 African countries by relating rainfall when a woman was in utero with her maternal survival later in her life. High levels of rainfall, representing better in utero conditions, decrease the probability of maternal death by 1.1 percentage points, a 58 % decrease from a mean of 1.9 %. Higher rainfall while in utero reduces the probability of anemia during pregnancy, a risk factor for postpartum hemorrhage. Another plausible pathway is through a reduction in body mass index, a predictor of pregnancy-induced hypertension. Improving conditions for pregnant women will have inter-generational effects, benefiting pregnant women today and improving their daughters’ maternal survival.