As we approach the 2015 deadline for the Millennium Development Goals, what does the future hold for international maternal mortality targets? The MHTF is pleased to be hosting a blog series on post-2015 maternal mortality goal setting. Over the next several weeks, we will be featuring responses and reactions to proposed targets from around the world. Please share your thoughts with us!
Between 1990 and 2010, the global number of maternal deaths declined by nearly half, and the maternal mortality ratio (MMR- the number of maternal deaths per 100,000 births) declined from 400 to 210. As 2015 comes closer, it is obvious we still have a long way to go. What is the target for post-2015?
Proposed Maternal Mortality Targets for 2035:
- An average global maternal mortality ratio of 50 by 2035.
- From 2010 to 2035, each country aims to reduce its maternal mortality ratio by 75-80% to achieve the global target. More specifically:
- Countries with an MMR above 400 aim to reach a minimum MMR of 100 / 100,000 live births.
- Countries with an MMR of 50 or lower aim to ensure equity among all subpopulations.
- Five-year milestones toward the 2035 target, based on 75% reduction since 2010, will help to know if a country is on target
Background
At a meeting at WHO in Geneva last April, a group of approximately 20 individuals working in the field of maternal health from Africa, Asia, Europe, and North America discussed possibilities for a post-2015 MMR target, starting with the four key components to target setting:
- defining an indicator;
- determining an end year;
- specifying a desirable annual rate of reduction;
- and selecting an end value.
Defining the indicator
There was consensus that the best indicator would be the MMR because it would provide continuity with the current MDG goal, and changes and differentials in the MMR are minimally affected by influences other than maternal mortality. Other common indicators considered included the number of maternal deaths, the maternal mortality rate (MMRate), the proportion of women’s deaths that are maternal (PM or PMDF), and the lifetime risk of a maternal death (LTR).Setting the end year
2025, 2030, or 2035 appear to be the main candidates for the end year of the post-MDG targets. The end year will presumably be selected through an international process that includes many sustainable development goals.Specifying the rate of reduction
For country targets, five-year milestones could be developed by each country that assumes a steady rate of decline and that would help countries to know if they are on track to achieve the goal set. However, while the annual rate of reduction need not be constant during the time interval, the average value should be feasible and ambitious.Determining the end value
The end value is largely determined by the choice of the end year and the annual rate of reduction, with rounding for the sake of simplicity.
Varying Country Contexts
As discussion continues about global and country target setting, it is important to consider country context and how it influences what is achievable. For example, 77 countries have already achieved a maternal mortality ratio of 50 or lower and, among this group, 58 have already reached a MMR of 30 or lower. In these countries, the emphasis should shift to equity, focusing on reaching an MMR of 50 or lower for all regions and sub-groups.
At the other end of the spectrum, in 2010, 26 countries still had a maternal mortality ratio of more than 400 deaths per 100,000 live births. For them, a target of 100 by 2035 is proposed, even though it would require a reduction of more than 75%. Milestones set for each five-year period would help to measure progress towards the target.
What goals make the most sense for your country? Let us know! Email Andrea Goetschius (goetschi@hsph.harvard.edu) to add your response to the blog series.