In the developing world, one way to reduce maternal mortality is to train professional midwives for both health facility and home deliveries. But what does the bigger picture of maternal mortality look like today?
The global maternal mortality ratio has fallen by 45% between 1990 and 2013, according to new estimates released today. This means that the world went from 380 maternal deaths per 100,000 live births in 1990 to 210 deaths per 100,000 live births in 2013. While this decline represents substantial progress, the actual rate of decline is insufficient to reach Millennium Development Goal 5 (MDG 5) – a three-quarter reduction in 1990 levels by 2015. To truly reach the target, an annual average reduction of 5.5% would be needed between 1990 and 2015.
The maternal mortality ratio measures the number of maternal deaths per 100,000 live births. It is a risk of dying due to maternal causes per 100,000 births. The number of maternal deaths is a number of deaths of women due to maternal causes. Precisely defined, it is a death of women while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
Key Facts about Maternal Mortality:
- 99% of all maternal deaths occur in developing countries.
- Every day, approximately 800 women die from causes related to pregnancy and childbirth that are mostly preventable.
- Young adolescents face a higher risk of complications and death as a result of pregnancy than older women.
- Skilled care before, during, and after childbirth can save the lives of women and newborn babies.
- Between 1990 and 2013, maternal mortality ratio worldwide dropped by 45%
Source: World Health Organization
Let’s take a closer look at the levels of progress in the regions. Sub-Saharan Africa and South Asia had the highest maternal mortality ratio in 1990 among the six developing regions. For progress over time, South Asia shows the highest annual rate of reduction at 4.4% since 1990, whereas Sub-Saharan Africa has the second lowest annual rate of reduction at 2.9%.
Why do women die?
Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy. Other complications may exist before pregnancy but are worsened during pregnancy. The major complications that account for maternal deaths are:
- Severe bleeding (mostly bleeding after childbirth)
- High blood pressure during pregnancy (pre-eclampsia and eclampsia)
- Infections (usually after childbirth)
- Obstructed labor and other direct causes
- Unsafe abortion
- Pre-existing medical conditions exacerbated by pregnancy (such as diabetes, malaria, HIV, obesity)
Source: World Health Organization
These new estimates show the number of maternal deaths has almost halved in 23 years globally – from 523,000 in 1990 to 289,000 in 2013. In the three regions where the reduction in the number of maternal deaths is more than 60% since 1990 – East Asia and Pacific, Europe and Central Asia, and South Asia – this progress is especially impressive. The other two regions, Latin America and the Caribbean as well as the Middle East and North Africa, show the reduction of more than 40% of maternal deaths. Only Sub-Saharan Africa shows less than 20% of reduction in the number of maternal deaths since 1990.
Although the number of maternal deaths per year has declined worldwide, the share of maternal deaths is increasingly concentrated in Sub-Saharan Africa. In 2013, 62 percent of worldwide maternal deaths occurred in Sub-Saharan Africa, compared to 42 percent in 1990. Sub-Saharan Africa is the only region where the share has increased this much, indicating that the reduction of maternal deaths is slower than the other regions. Better maternal health care and lowering fertility can reduce and prevent maternal deaths.
The reality is that most high-mortality countries do not have reliable vital registration systems, so the measurement of the maternal mortality relies largely on modeling using data from surveys, censuses, and socioeconomic variables. The United Nations Maternal Mortality Estimation Inter-agency Group (UN MMEIG) began its work in the mid-1990s with the goal to provide more reliable and transparent maternal mortality data through comparable global, regional, and country estimates. The UN MMEIG includes the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), the World Bank Group, and the United Nations Population Division. These new UN MMEIG maternal mortality estimates are available in World Bank’s World Development Indicators database and the HealthStats site.