Maternal deaths continue to decline but more needs to be done

GENEVA / NEW YORK | 6 May 2014 – Global maternal mortality has declined by approximately 45% since 1990, according to a new United Nations report titled Trends in maternal mortality estimates 1990 to 2013. The number of women dying due to complications in pregnancy and childbirth, in fact, went from 523 000 in 1990 to 289 000 in 2013. Data also indicates that eleven countries with high maternal mortality rates in 1990 (Bhutan, Cambodia, Cabo Verde, Equatorial Guinea, Eritrea, Lao People’s Democratic Republic, Maldives, Nepal, Romania, Rwanda, and Timor-Leste) have already reached the Millennium Development Goal 5 (MDG 5) target of reducing the maternal mortality ratio by 75% between 1990 and 2015. However, the study warns that, without accelerated interventions, several low- and middle-income countries, especially those in sub-Saharan Africa, will fall short of achieving MDG 5 by the 2015 deadline.

The report describes particular policies and strategies taken by some of the countries that are ‘on track’ to meet the MDG 5 target. For instance, Rwanda has deployed community health workers and volunteers to remote and rural areas in order to meet local health needs. At the same time, the country invested in its long-term vision by strengthening its educational and training institutions as well as building partnerships with international medical, nursing, dental, and health management colleges.

“Together, the two reports highlight the need to invest in proven solutions, such as quality care for all women during pregnancy and childbirth, and particular care for pregnant women with existing medical conditions,”

Dr Flavia Bustreo

A related investigation by the World Health Organization (WHO), also published today in The Lancet Global Health, analyses the causes of over 60 000 maternal deaths in 115 countries. The article shows that 28% of maternal deaths are due to pre-existing medical conditions (such as diabetes, HIV, malaria, and obesity), whose health impacts can all be exacerbated by pregnancy. Other causes of death include severe bleeding, pregnancy-induced high blood pressure, infections, obstructed labour, abortion complications, and blood clots (embolism).

“Together, the two reports highlight the need to invest in proven solutions, such as quality care for all women during pregnancy and childbirth, and particular care for pregnant women with existing medical conditions,” says Dr Flavia Bustreo, Assistant Director-General, Family, Women’s and Children’s Health, WHO.

Clearly, the lack of a skilled health workforce represents a major hurdle in attaining the MDG 5. This is why the Global Health Workforce Alliance is calling upon governments, NGOs, and civil society organizations to fulfil the commitments made at the Third Global Forum on Human Resources for Health and support health workers worldwide. Strong health systems – with facilities that have adequate health workers and equipment and medicines – are key to delivering quality health care to save the lives of women and their newborn babies.

Highlights from Trends in maternal mortality estimates 1990 to 2013:
  • Maternal mortality has declined: In 2013, the global maternal mortality ratio (MMR) was 210 maternal deaths per 100 000 live births, down from 380 maternal deaths per 100 000 live births in 1990 (a 45% reduction).
  • Faster progress needed: The global reduction of MMR has accelerated, with a 3.5% annual decline from 2000-2013, as compared with 1.4% between 1990 and 2000. However, at current trends, most countries will not achieve the MDG target of a 75% reduction in MMR from 1990 to 2015. An average decline of 5.5% or more every year since 1990 is needed to meet the target on time.
  • Ten countries carry most of the burden: Ten countries account for about 60% of global maternal deaths: India (50 000), Nigeria (40 000), Democratic Republic of the Congo (21 000), Ethiopia (13 000), Indonesia (8800), Pakistan (7900), United Republic of Tanzania (7900), Kenya (6300), China (5900) and Uganda (5900).
  • Somalia and Chad have the highest risk: The highest lifetime risk of maternal death is in Somalia and Chad where women face a 1 in 18 and 1 in 15 lifetime risk respectively
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