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Maternal mortality: Why have some regions seen progress while others struggle?

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Nursing mother in Sri Lanka hospital (Credit: Simone D. McCourtie/World Bank)

New estimates released today by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), and the World Bank show that the number of women dying due to complications in pregnancy and childbirth has almost halved in 20 years—from more than 540,000 in 1990 to less than 290,000 in 2010.

This is good news, but it doesn’t tell the whole story. While substantial progress has been achieved at the global level, many countries, particularly in sub-Saharan Africa, will still fail to reach the Millennium Development Goal (MDG 5) target of reducing maternal mortality by 75% from 1990 to 2015.

Why have some developing regions seen progress on MDG 5 while others still struggle? Given different regional and country contexts, it’s a challenge to find a one-size-fits-all explanation. Improvements in health systems, expanded education for girls and increased physical accessibility to health facilities could be contributing factors, but a closer look at progress on other MDG 5 indicators offers a clearer picture.

As the chart below indicates, the proportion of deliveries attended by skilled health workers in developing regions rose from 55% in 1990 to 65% in 2009. Similarly, the proportion of women who were attended by skilled health care personnel at least once during their pregnancy rose from 64% to 81%, while the proportion of women aged 15-49 who use any method of contraception increased from 52% to 61%.

More recently, the rapid roll-out of antiretroviral therapy in sub-Saharan Africa to HIV-positive women, from
Together, these interventions can be seen as the “building blocks” of an effective strategy to reduce maternal deaths. For countries that have already met MDG 5—Bhutan, Nepal and Equatorial Guinea, for example—they’ve worked well.

But let’s keep our eye on the disparities that persist within and across regions, and on the places where the building blocks haven’t yet come together. For example, East Asia, which experienced the greatest decline in the maternal mortality ratio, has a contraceptive prevalence rate of 84%, as opposed to 22% in sub-Saharan Africa, the region with the lowest MMR declines.

Efforts to improve maternal health should focus on addressing these inequalities as part of a broader health systems strengthening approach.


Reproductive health indicators in developing regions, 1990 and 2009 (percentage) (Source: UN)



Report: Trends in Maternal Mortality: 1990 to 2010

Website: World Bank and Reproductive Health

Video: Health Systems Create Healthy Futures


Samuel Mills

Senior Health Specialist, Health Nutrition & Population Global Practice at the World Bank Group

Emi Suzuki

Demographer, Development Data Group, World Bank

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