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MATERNAL MORTALITY TRENDS, 1990-2010

Thursday, 24th of May 2012

MATERNAL MORTALITY TRENDS, 1990-2010

Executive summary

The high-level Commission on Information and Accountability for Women’s and Children’s

Health included among its 10 recommendations one that is specific to improving

measurement of maternal (and child) deaths. This recommendation requires that “by 2015,

all countries have taken significant steps to establish a system for registration of births,

deaths and causes of death, and have well-functioning health information systems that

combine data from facilities, administrative sources and surveys”. Considering that only

a third of countries are characterized as having a complete civil registration system with

good attribution of cause of death, it is imperative that countries with incomplete civil

registration systems take steps to strengthen those systems. This will tremendously

improve the estimation of maternal mortality and monitoring of the Millennium Development

Goal (MDG) 5: Improve maternal health. The two targets for assessing MDG 5 are reducing

the maternal mortality ratio (MMR) by three quarters between 1990 and 2015, and

achieving universal access to reproductive health by 2015.

The estimates on maternal mortality presented in this report are the sixth in a series of

exercises by the United Nations agencies. For the second time, the Maternal Mortality

Estimation Inter-Agency Group (MMEIG), comprising the World Health Organization (WHO),

United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA), the

United Nations Population Division, and The World Bank, together with a team at the

University of California at Berkeley, United States of America have been working together

to generate internationally comparable MMR estimates. A technical advisory group (TAG)

provides independent technical advice to MMEIG. Based on the achievement from the last

round, newly available data collected by MMEIG and obtained during country consultation

were incorporated, and trend estimates from 1990 to 2010 were generated.

Globally, an estimated 287 000 maternal deaths occurred in 2010, a decline of 47% from

levels in 1990. Sub-Saharan Africa (56%) and Southern Asia (29%) accounted for 85% of

the global burden (245 000 maternal deaths) in 2010. At the country level, two countries

account for a third of global maternal deaths: India at 19% (56 000) and Nigeria at 14%

(40 000).

The global MMR in 2010 was 210 maternal deaths per 100 000 live births, down from 400

maternal deaths per 100 000 live births in 1990. The MMR in developing regions (240) was

15 times higher than in developed regions (16). Sub-Saharan Africa had the highest MMR

at 500 maternal deaths per 100 000 live births, while Eastern Asia had the lowest among

MDG developing regions, at 37 maternal deaths per 100 000 live births. The MMRs of the

remaining MDG developing regions, in descending order of maternal deaths per 100 000

live births are Southern Asia (220), Oceania (200), South-eastern Asia (150), Latin

America and the Caribbean (80), Northern Africa (78), Western Asia (71) and the Caucasus
and Central Asia (46).

A total of 40 countries had high MMR (defined as MMR ≥300 maternal deaths per 100 000

live births) in 2010. Of these countries, Chad and Somalia had extremely high MMRs

(≥1000 maternal deaths per 100 000 live births) at 1100 and 1000, respectively. The other

eight highest MMR countries were: Sierra Leone (890), the Central African Republic (890),

Burundi (800), Guinea-Bissau (790), Liberia (770), the Sudan (730), Cameroon (690) and

Nigeria (630). Although most sub-Saharan African countries had high MMR, Mauritius (60),

Sao Tome and Principe (70) and Cape Verde (79) had low MMR (defined as 20–99 maternal

deaths per 100 000 live births), while Botswana (160), Djibouti (200), Namibia (200),

Gabon (230), Equatorial Guinea (240), Eritrea (240) and Madagascar (240) had moderate

MMR (defined as 100–299 maternal deaths per 100 000 live births). Only four countries

outside the sub-Saharan African region had high MMR: the Lao People’s Democratic

Republic (470), Afghanistan (460), Haiti (350) and Timor-Leste (300).

Sub-Saharan Africa had the largest proportion of maternal deaths attributed to HIV at

10%, while the Caribbean had the second largest at 6%. Of the 19 000 maternal deaths

due to HIV/AIDS worldwide, 17 000 (91%) are in sub-Saharan Africa, while 920 (5%)

occurred in Southern Asia. Further, for some countries in Southern Africa, such as

Botswana, Lesotho, Namibia, South Africa and Swaziland, MMR increased from the year

1990 to 2000, mainly as a result of the HIV epidemic; in these countries, the MMR is now

declining as antiretroviral therapy is becoming increasingly available.

The fifth MDG aims to improve maternal health, with a target of reducing the MMR by 75%

between 1990 and 2015. The percentage reductions for the 10 countries that have

already achieved MDG 5 by 2010 are: Estonia (95%), Maldives (93%), Belarus (88%),

Romania (84%), Bhutan (82%), Equatorial Guinea (81%), Islamic Republic of Iran (81%),

Lithuania (78%), Nepal (78%) and Viet Nam (76%). For the remaining countries, one way

to gauge progress is to examine whether they have had the expected average annual

decline of 5.5% in the MMR from 1990 to 2010. Among countries with MMR ≥100 in 1990,

nine countries are “on track”, in addition to those mentioned above: Eritrea (6.3%), Oman

(6.2%), Egypt (6%), Timor-Leste (6%), Bangladesh (5.9%), China (5.9%), Lao People’s

Democratic Republic (5.9%), Syrian Arab Republic (5.9%) and Cambodia (5.8%). Further,

Poland (6.1%) and Turkey (5.8%) have experienced average annual declines of more than

5.5% but because the MMR in 1990 was <100 maternal deaths per 100 000 live births,

they are not categorized as being on track. Moreover, 50 countries are “making progress”.

Conversely, 14 countries have made “insufficient progress”, and 11 are characterized as

having made “no progress” and are likely to miss the MDG target unless accelerated

interventions are put in place.

Full text is at http://www.unfpa.org/webdav/site/global/shared/documents/publications/2012/Trends_in_maternal_mortality_A4-1.pdf

Maternal Deaths Plunged Over 2 Decades, to About 287,000 in 2010, U.N. Reports

By DONALD G. McNEIL Jr.

New York Times, Published: May 16, 2012

The number of women dying from pregnancy and childbirth has dropped sharply in the last two decades, according to a report by a consortium of United Nations agencies set to be released on Wednesday.

Maternal deaths fell to about 287,000 in 2010, the report said. The decline is attributable to increases in contraception and in antiretroviral drugs for mothers with AIDS, and to greater numbers of births attended by nurses, doctors or midwives with medical training.

The agencies said the deaths had fallen by 47 percent from the United Nations’ 1990 estimate of 543,000, but the organization has been revising its historical estimates in response to skeptical research by a rival group of epidemiologists at the University of Washington.

Two years ago, that group, the Institute for Health Metrics and Evaluation, which was founded by the Bill and Melinda Gates Foundation as a sort of check on the World Health Organization, contradicted a long-held United Nations finding that maternal deaths had remained stubbornly above 500,000 a year.

In a widely publicized study in the journal The Lancet in April 2010, the institute estimated that 343,000 maternal deaths took place in 2008. It used three times as much data from census and death records, scientific studies and other sources as previous United Nations reports had.

In response, five months later, the United Nations said it had “revised and improved” its own statistics and concluded that there were 358,000 deaths in 2008.

“When they saw our results, they changed their strategy,” said Dr. Rafael Lozano, an epidemiologist at the institute.

Last fall, the institute estimated that deaths would fall to 274,000 in 2011. The new United Nations estimate of 287,000 is within the same statistical boundaries, Dr. Lozano said.

The United Nations report also concludes that deaths are falling quickly in East Asia but slowly in Africa.

The Asian reduction is attributed largely to China, which has a one-child policy, a very high use of contraceptives and a health care system that is improving as the nation gets richer.

Southern African countries have seen the beginnings of a reversal, according to the United Nations report, which was compiled by the World Health Organization, the United Nations Children’s Fund, the United Nations Population Fund, the United Nations Population Division, the World Bank and a team from the University of California, Berkeley. A decade ago, maternal deaths in southern Africa were rising because of AIDS. As more women get drugs that restore their immune systems, deaths are dropping.

Just two countries, India and Nigeria, account for one-third of the world’s maternal deaths. Others with very high numbers include the Democratic Republic of Congo, Pakistan, Sudan, Indonesia, Ethiopia, Tanzania, Bangladesh and Afghanistan.

“There were rumors at a U.N. conference last fall that the new numbers would be in the 200,000s,” said Christy Turlington Burns, a former fashion model who founded Every Mother Counts to fight global maternal mortality after she nearly died in childbirth.

“I’m delighted to see them come down,” she added after speaking at a health conference in New York on Tuesday. “It didn’t do any good when different reports diverged by 100,000 — or when the drop seemed so rapid. That sent a message that it’s easier to save lives than it is.”