The MHTF is soliciting reactions from the maternal health community to the newly released UN MMR data. Our hope is that, together, these comments will serve as a springboard for discussion and provide momentum towards MDG5.
The World Health Organization (WHO) recently published a report entitled “Trends in Maternal Mortality: 1990 to 2008” (2010). After assessing global maternal mortality rates (MMRs) over an 18 year span, the report estimates that by 2008 MMRs declined by 34%. While we at WINGS applaud the achievements that have helped reduce maternal deaths worldwide, we remain alert to the fact that MMRs are likely still much larger than estimated. For instance, while 99% of all maternal deaths take place in the developing world, as the WHO report itself notes, researchers face the most difficulties finding reliable and accurate data in developing countries. Data sets used to estimate MMRs are often incomplete and inaccurate. They include misidentification of cause of death, incongruent definitions, underreporting, for example in the case of abortions, and a lack of comparability across different countries and data sources.
The authors of the WHO report are well-aware of the data’s limitations and make considerable efforts to compensate for these problems. One measure undertaken was to divide countries into A, B or C categories depending on the availability and quality of data. This, however, must be regarded with caution. Guatemala was categorized as an A country, suggesting that it has a complete civil registration system allowing for good attribution of cause of death. However, as WINGS is well-aware, after working in Guatemala on reproductive health issues for almost 10 years, governmental reporting on maternal deaths in Guatemala is far from reliable. Reports on Guatemala’s MMRs differ widely depending on which source one looks at. For example, a UNICEF report published in 2009 estimates that the MMR from 2003-2008 in Guatemala was 130 per 100,000. The report, however, goes on to adjust that figure to 290 per 100,000 women to account for the lack of government reporting (or misreporting). This is in stark contrast to the recent figures in the WHO report, which suggest that in 2008 Guatemala’s MMR for every 100,000 live births was only 110. The report further notes that Guatemala’s MMR has only decreased 1.7% a year from 1990 to 2008. While this is already far below the Millennium Development Goal (MDG) of 5.5% a year, due to the report’s low estimation of Guatemala’s MMR, a 1.7% decrease might even be considered optimistic. If such different estimations exist for a country listed as having a fairly high level of data, one can only imagine the discrepancies for those countries listed as lacking sufficient registration systems.
While the WHO’s estimations should be viewed cautiously, the report does a good job of highlighting the need for improved data on maternal mortality the world over. Additionally, while reporting a decrease in global maternal mortality, the report does its best to argue against complacency. As noted, much more work is needed before the MDG of reducing the global MMR by 75% can be achieved. WINGS congratulates all those that are diligently working towards this goal.
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