For those of us working to improve the health of women and children around the world, this is the kind of news we wait for with great anticipation: This week, the Institute for Health Metrics and Evaluation (IHME) and the World Health Organization (WHO), UNICEF, UNFPA, World Bank and United Nations published new estimates quantifying the burden of maternal mortality around the world. The deadline for achieving the Millennium Development Goals (MDG) is just around the corner in 2015—and these reports represent a critical metric of how we, maternal health professionals, are faring at achieving our joint goal of saving mothers’ lives. These reports also provide important insights into where attention must be focused and how maternal mortality will fit into the next set of sustainable development goals.
While these are estimates and some differences exist between the two reports, the big picture is that maternal mortality continues to decline. Here are the major headlines from each of the reports:
- Number of maternal deaths globally: 292,982 (261,017-327,792) in 2013 down from 376,034 (343,483-407,574) in 1990.
- Global maternal mortality ratio (MMR) in 2013: 209 maternal deaths/100,000 live births.
- MMR range between countries from highest to lowest: South Sudan (956.8); Iceland (2.4).
- Global annual rate of decline (MMR): 0.3% from 1990-2003; 2.7% from 2003-2013
- Maternal mortality by age: highest MMR among women 40-49 years old (in both 1990 and 2013); lowest MMR among women 20-29 year olds (in both 1990 and 2013); 9.5 % of all maternal deaths are among adolescents aged 15-19, an age group with an MMR only slightly higher than that of the 20-24 and 25-29 year old age groups.
- Timing of deaths: on average, nearly a quarter of deaths (24.6%; 24.1-25.2) occurred antepartum; a quarter intrapartum and immediately postpartum (27.7%; 27.1-28.2); a third subacute and delayed postpartum (35.6%; 34.9-36.2); and 12.1% (11.9-12.5) late maternal deaths.
- Cause of death: Causes of maternal death vary significantly by country and income level. In high-income countries, the distribution of causes has changed, with indirect causes being in 2013 the most common ones. Abortion-related death, which was the most important cause of death in high-income countries in 1990, represented a much smaller proportion in 2013. The most important causes of maternal death (such as other direct, abortion and hemorrhage) in low-income countries did not change significantly between 1990 and 2013 with some differences and important trends by region.
- Maternal deaths related to HIV in 2013: 2070 deaths represent only 0.4% of all maternal deaths worldwide, but 1.5 % of all maternal deaths in sub-Saharan Africa, rising to 6.2% in southern sub-Saharan Africa. The absolute number of HIV-related deaths did not decrease significantly from 1990-2013.
- Abortion-related deaths: decreased everywhere but Oceania (where there was no change) and sub-Saharan Africa where the number of deaths after abortion increased significantly.
- Proportion of maternal deaths due to indirect causes: globally, they increased slightly from 9.1% (8.9-9.4) in 1990 to 10.2% in (10.0-10.5) in 2013.
- Higher income countries with MMR lower than 30: slow rates of reduction since 1990 everywhere but the US, where the maternal mortality ratio is actually increasing.
- Number of maternal deaths globally: 289,000 in 2013 down from 523,000 in 1990.
- Global maternal mortality ratio (MMR) in 2013: 210 maternal deaths/100,000 live births (160-290).
- MMR range between countries from highest to lowest: Sierra Leone (1100; 580-2000); Israel (2;1-4).
- Global annual rate of decline (MMR): 2.6%.
- Achievement of Millennium Development 5 goal (Decrease of 75% in MMR from 1990): 11 countries with high levels of maternal mortality in 1990 have already reached their MDG target; 63 considered to be “making progress”; still, most countries will not achieve this goal.
- Greatest burden of maternal mortality: 10 countries with greatest burden (60% of maternal deaths): India, Nigeria, DRC, Ethiopia, Indonesia, Pakistan, Tanzania, Kenya, China, and Uganda.
- Maternal deaths related to HIV in 2013: From 2003-2009, HIV counted for 5.5% of global maternal deaths; the overall proportion of HIV-related maternal deaths was highest in sub-Saharan Africa at 6.4%.
- Maternal deaths due to indirect causes: From 2003-2009, more than a quarter of deaths (27.5%) were attributable to indirect causes. The proportion of deaths from indirect causes was highest in southern Asia (29.3%) followed by sub-Saharan Africa (28.6%). Indirect causes accounted for nearly a quarter of the maternal deaths in developed regions. Breakdown on indirect causes of maternal death suggests that more than 70% of them are from pre-existing disorders, including HIV, when exacerbated by pregnancy.
The MHTF is pleased to announce the launch of a blog series on the new maternal mortality estimates and their implications on the global and country level efforts to eliminate preventable maternal deaths. Please share your thoughts! Send submissions of 400-600 words to Natalie Ramm.