As UN General Assembly Reviews MDGs, How Can the Next Global Development Framework Accelerate Progress on Maternal Health?

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By: Sarah Blake, MHTF consultant

When the United Nations General Assembly meets this week, world leaders will review progress toward the Millennium Development Goals (MDGs) and debate the next global development agenda. There is little question that the next framework will have a critical bearing on whether, and by how much, maternal mortality will be reduced in the coming years. The priority that maternal health and related issues, such as HIV and AIDS and family planning, receive in the global framework will influence health policy and programming around the world.

As a group of maternal health experts representing WHO and USAID pointed out in a commentary published in August in The Lancet Global Health:

 “Between 1990 and 2010, maternal mortality decreased globally by nearly 50%, from 543 000 maternal deaths per year to 287 000, with the greatest reductions in  the second half of this period. A major catalyst for this progress was the target set by Millennium Development Goal 5: reduction of the maternal mortality ratio by 75% between 1990 and 2015. Later, a second target on reproductive health was added, which has undoubtedly contributed to accelerated progress.”

Going in to the debate, there is good reason to believe that maternal health will remain on the agenda. In May, the High Level Panel of Eminent Persons (HLP), commissioned by UN Secretary Ban Ki-Moon recommended that the UN adopt a set of 12 interrelated goals, each supported by a set of ambitious targets for achieving a vision of sustainable development, that ensures that  the world of 2030 is “more equal, more prosperous, more peaceful, and more just.” Among the goals and targets, the HLP recommended that maternal mortality ratio be reduced to “no more than X deaths per 100,000 births” by 2030 as part of goal 4, which seeks to “Ensure Healthy Lives.” Unlike the MDG target, which proposed a 75 percent reduction in the maternal mortality ratio for all countries, regardless of what their MMR was at the baseline, this proposed measure would define progress against an absolute figure. Depending on how “X” is defined, then, many countries would start off having “achieved” the target, while others might be challenged to reduce their MMR by an even greater degree than the 75 percent set by the MDGs.

In the months since the HLP offered its recommendations, policy makers, researchers and others have begun to consider  the proposed goal, as well as the implications that the shift from a relative to an absolute measure would have for priorities in global and national efforts to improve maternal health.  For instance, the recent Lancet commentary proposed one response, suggesting that the UN adopt the overall target for countries to achieve an MMR of no more than 50 deaths/100,000 births by 2035, along with more specific targets and national strategies for countries that currently have maternal mortality ratios of over 400 deaths/100,000 births, as well as for addressing inequities within countries where overall maternal mortality is relatively close to the target (under 100/100,000) by focusing on improving maternal health among subpopulations with higher than average maternal mortality rates. At the same time, the authors called for new strategies and approaches to measure and reduce maternal mortality.

The General Assembly debate provides an important opportunity to reflect on the progress, challenges and lessons learned under the MDGs, and to consider the best ways of  accelerating global and national progress toward reducing maternal mortality after 2015.

We want to hear from you. What role do you think MDG5 has played in accelerating progress toward reducing maternal mortality? Has the time come to shift to an absolute target, or is a relative measure more useful? What challenges and opportunities do you see in the proposed overall framework which groups maternal health with other health issues? Is reducing the maternal mortality ratio the best way to measure progress toward ending preventable maternal deaths, or would a different measure be more useful?