Many countries are making significant progress in reducing maternal mortality, such as China, Egypt, Ecuador and Bolivia, with a number on track to meet Millennium Development Goal 5 (MDG5). However, the data also reveal surprising increases in some high-income countries, for example the USA, Canada, and Denmark. The findings are published in an Article Online First and in an upcoming edition of the Lancet, by Dr Christopher Murray, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA, and colleagues.
The authors estimated maternal deaths in 181 countries for the period 1980-2008, from vital registration data, censuses, surveys, and verbal autopsy studies. Their analysis showed that the number of women dying from pregnancy-related causes has dropped by over 35% in the past 30 years – from more than a half-million deaths annually in 1980 to about 343,000 in 2008.
The research team also generated the maternal mortality ratio (MMR) for each country. MMR is the number of women dying for every 100,000 live births. They found that globally, MMR declined from 422 in 1980 to 320 in 1990. It fell to 251 in 2008, and is, say the authors, on track for further decreases.
Dr Murray says the findings are contrary to previous research, which showed very little change in the maternal mortality ratio (MMR). This new research from IHME shows that maternal deaths have been declining at an annual rate of about 1.4% between 1990 and 2008.
The researchers found that progress in reducing maternal mortality has been slowed by the ongoing HIV epidemic. Nearly one out of every five maternal deaths – a total of 61,400 in 2008 – can be linked to HIV, and many of the countries with large populations affected by HIV have had the most difficulty reducing their maternal mortality ratio.
Almost 80% of all maternal deaths were concentrated in 21 countries in 2008, while 50% were in only six countries (India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo), The best performing country was The Maldives, with an annual MMR drop of 8•8% between 1990 and 2008, while Zimbabwe was the worst performing nation, with an annual MMR increase of 5•5% over the same period.
Developing countries, in particular, have made substantial progress toward MDG5 (reducing MMR by 75% during the period 1990-2015)—this is despite only 23 countries* being on track to achieve the target of lowering the MMR by 75% between 1990 and 2015. Countries such as Egypt, China, Ecuador, and Bolivia have been achieving accelerated progress in decreasing their MMR.
One of the most surprising findings was the increased MMR in the USA, from 12 in 1990 to 17 in 2008—an increase of 42%. The authors say that this trend could be partly due to changes in the way maternal deaths are reported, but add that does not explain why maternal deaths in the USA are occurring at more than double the rate in the UK, three times the rate in Australia and four times the rate in Italy. Canada's MMR also increased from 6 to 7 over the same period, while Denmark's increased from 7 to 9. Austria, Norway, and Singapore also recorded rises.
Many countries of Western Europe followed a similar trend, with decreases between 1980 and 1990 followed by a levelling off to 2008. The countries with the lowest MMR in 2008 in this region were Italy (the lowest in the world at 4) and Luxembourg and Sweden (5). The UK MMR was 8, with Germany and Spain at 7 and France at 10.
Chile and Uruguay had the lowest MMRs in South America (21 and 25 respectively), with Bolivia, despite its accelerated decrease, still having the highest at 180. Performance across Africa was mixed, with some countries showing sharp annual rises in MMR (for example Democratic Republic of Congo, Zimbabwe, and Mozambique) while others showed extremely promising progress (including Equatorial Guinea, Eritrea, Ethiopia, Somalia, and Sudan).
Australia continues to have one of the lowest MMRs worldwide at 5, while China has seen a steep drop from 165 in 1980 to 40 in 2008. Vietnam, the Philippines and Laos were among the countries that saw a steep decline in Asia.
Dr Murray said: "These findings are very encouraging and quite surprising. There are still too many mothers dying worldwide, but now we have a greater reason for optimism than has generally been perceived."
He adds: "Finding out why a country such as Egypt has had such enormous success in driving down the number of women dying from pregnancy-related causes could enable us to export that success to countries that have been lagging behind."
He concludes: "In a year where there has been unprecedented policy interest in improving maternal and child health, this is a remarkable story of undiscovered progress that countries can build on in their efforts to reach international goals."
In an accompanying Comment, Lancet Editor Dr Richard Horton describes the overall data as 'robust reason for optimism'. He adds that the data explicitly lay bare the intimate connection between HIV and maternal health.
He adds: "Given the dramatic difference between the results of these estimates and those last reported by the UN, a process needs to be put in place urgently to discuss these figures, their implications, and the actions, global and in country, that should follow. Ban Ki-moon is currently leading a Joint Effort on Women's and Children's Health. The purpose is to plan measures for the MDG Summit in September. One outcome of the UN Secretary-General's important initiative might be to convene a high-level, intergovernmental MDG preparatory meeting as a satellite event at Women Deliver in June. The goal of such a preparatory meeting would be to bring the best available data to bear on formulating policies to launch in September."
He concludes: "Two decades of concerted campaigning by those dedicated to maternal health is working. Even greater investment in that work is likely to deliver even greater benefits. Women have long delivered for society, and, slowly, society is at last delivering for women. This is a moment to celebrate—and accelerate."
For Dr Christopher Murray, please contact either William Heisel or Jill Oviatt, IHME Communications. Jill Oviatt T) +1 (206) 897-2862 /+1 (206) 861-6684 E) oviattj@uw.edu William Heisel T) +1 (206) 897-2886 / + 1 (206) 612-0739 E) wheisel@uw.edu
For Dr Richard Horton, Editor, The Lancet, please contact Tony Kirby, Lancet Press Office. T) +44 (0) 20 7424 4949 E) tony.kirby@lancet.com
For full Article see: http://press.thelancet.com/mmm.pdf
For full Comment from Richard Horton see: http://press.thelancet.com/mmmrh.pdf
Note to editors: *Countries on track to meet MDG5 (>5.5% decline in MMR per year)
Maldives, Egypt, Bhutan, Albania, Tunisia, El Salvador, United Arab Emirates, Lao People's Democratic Republic, Oman, Romania, Qatar, Saudi Arabia, Lebanon, Libyan Arab Jamahiriya, Syrian Arab Republic, Morocco, Turkmenistan, Cape Verde, Myanmar, Jordan, Poland, Algeria, Bosnia and Herzegovina
Journal
The Lancet