The Lancet’s Editor Richard Horton Provides Commentary on Recent MMR Estimates

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By: Katie Millar, Technical Writer, Women and Health Initiative, Harvard T.H. Chan School of Public Health

If you have been following the news and our MMR Estimates Blog Series, you know that the WHO and IHME recently released new global estimates for maternal mortality. These estimates have strong implications for global maternal health goals as they will be used as baselines for Post-2015 targets.

Dr. Richard Horton, Editor-in-Chief at The Lancet, recently addressed a common concern with these estimates—the estimates differ greatly at a regional and country level. Dr. Horton points out, “These differences are not at all obvious when one examines the headline numbers from each source. IHME’s global estimate for maternal deaths is 292,982. The equivalent UN figure is 289,000. But at the regional level, big differences begin to appear.” In fact, 15 of the 75 countries with the highest burden of maternal mortality have estimates that differ by 1,041 to 21,792 maternal deaths. The discrepancy of 21,792 deaths falls on India—the country with the highest number of maternal deaths in the world.

For a country that needs to strategize well to address this high burden of disease, India is faced with a discrepancy that could affect how they respond. Dr. Horton says, “[If] you were India’s new Prime-Minister-elect, Narendra Modi, you might just alter the urgency with which you acted to reduce maternal mortality if you believed the UN figure, which records a remarkable 21,792 fewer maternal deaths than the independently calculated estimate from a competing large international collaboration. It would not be unreasonable if other Presidents and Prime Ministers, let alone Ministers of Health, were confused by these often strikingly divergent results.” The discrepancies not only affect the important decisions of country officials, but also affect the credibility of the estimates themselves.

So what can be done to address these discrepancies? Dr. Horton suggests reviewing the methods and models used to generate these estimates. “[The] Gates Foundation funded Independent Advisory Committee for the Global Burden of Disease… meets next month in Seattle. One of its remits is to ‘engage in dialogue with other efforts on global health estimates.’ A further goal is to review strengths and weaknesses of the GBD’s methods. But this second objective will solve only half of the problem. Someone also needs to assess the strengths and weaknesses of the UN’s methods. [The Independent Advisory Committee for the Global Burden of Disease] could consider conducting a careful comparison of methods used by both the UN and IHME.”

The most important conclusion of this discussion is that country leaders need accurate data to effectively mitigate maternal mortality. As the common management adage teaches us, “You can’t manage what you can’t measure.” Hopefully with increased collaboration we can bridge the gap between UN and IHME estimates for maternal mortality.