Maternal mortality fell by a third over 18 years, says UNBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5068 (Published 15 September 2010) Cite this as: BMJ 2010;341:c5068
The number of women worldwide dying from complications during pregnancy and childbirth each year fell by 34% between 1990 and 2008, from 546 000 to 358 000, show new data from the World Health Organization, Unicef, the United Nations Population Fund, and the World Bank.
“The global reduction in maternal death rates is encouraging news,” said Margaret Chan, WHO’s director general. “Countries where women are facing a high risk of death during pregnancy or childbirth are taking measures that are proving effective; they are training more midwives and strengthening hospitals and health centres to assist pregnant women.”
In the world’s developing regions the largest fall in maternal mortality was posted by Eastern Asia (with a decrease of 63%), followed by South Eastern Asia (57%), and South Asia (53%). It fell by 41% in Latin America and the Caribbean, 26% in Sub-Saharan Africa, and 22% in Oceania.
However, the agencies, in their joint report on the new estimates, emphasise that although the progress is notable, the annual rate of decline is less than half of what is needed to achieve the target under the fifth millennium development goal of reducing the maternal mortality ratio (the number of deaths per 100 000 live births) by 75% between 1990 and 2015 (BMJ 2010;341:c5017, 14 Sep, doi:10.1136/bmj.c5017).
Globally, the average decrease between 1990 and 2008 was just 2.3%, substantially below the annual decline in the ratio of 5.5% from 1990 to 2015 needed to achieve the target.
The least progress was achieved in Oceania and Sub-Saharan Africa, where the ratio fell, respectively, by only 1.4% and 1.7%.
“None of the broad MDG [millennium development goal] regions was on track to achieve MDG 5, although Eastern Asia was very close at 5.5%,” concludes the report.
Anthony Lake, Unicef’s executive director, said that more needs to be done to reach women who are most at risk: “That means reaching women in rural areas and poorer households, ethnic minorities, and indigenous groups, and women living with HIV and in conflict zones,” he said.
The new data show that developing countries continued to account for 99% of the deaths, or 355 000 in 2008. Sub-Saharan Africa and South Asia combined accounted for 87% of the world’s maternal deaths, with 204 000 and 109 000 deaths, respectively.
Moreover the study shows that 11 countries—Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan, Sudan, and Tanzania—accounted for 65% of all maternal deaths in 2008.
The country with the largest number of maternal deaths was India (63 000) followed by Nigeria (50 000), the Democratic Republic of the Congo (19 000), and Afghanistan (18 000).
The new estimates, which were based on new methods and more databases and other sources from 172 countries, show that among sub-Saharan African nations the biggest drops in the ratio were in Equatorial Guinea (with a fall of 73%), Eritrea (69%), and Cape Verde (58%). Other countries saw increases, with the biggest in sub-Saharan Africa occurring in Botswana (up 133%), Zimbabwe (102%), and South Africa (80%), largely a result of the high prevalence of HIV in southern Africa.
The report points out that 9% of all maternal deaths in sub-Saharan Africa were related to HIV and AIDS.
Sub-Saharan Africa also had the highest maternal mortality ratio, at 640 deaths per 100 000 live births in 2008, followed by South Asia (280) and Oceania (230).
The report says that 45 countries had a ratio of ≥300 per 100 000 live births, with four having extremely high rates of ≥1000 deaths per 100 000: Afghanistan (1400), Chad and Somalia (1200 each), and Guinea Bissau (1000).
Overall, during 1990 to 2008, 147 countries registered declines in the ratio, 90 of which notched a decrease of 40% or more; 23 nations saw an increase; and two countries reported no change.
Cite this as: BMJ 2010;341:c5068
Trends in Maternal Mortality: 1990 to 2008 is at www.who.int/reproductivehealth/publications/monitoring/9789241500265/en/index.html. See Editorial, BMJ 2010;341:c5045, doi:10.1136/bmj.c5045.