ESA/STAT/AC.219/16

Trends in maternal mortality

1990-2008

Holly Newby

Statistics and Monitoring Section

Released September 2010

Includes trends for 172 countries

UN inter-agency estimates for 2008

Maternal Mortality Estimation Inter-agency Group (MMEIG)

The 2008 UN inter-agency estimates were produced by the Maternal Mortality Estimation Inter-agency Group (MMEIG):

• WHO • UNICEF • UNFPA• The World Bank• Technical Advisory Group

Definitions

Methodological approach

Findings

Definitions

Methodological approach

Findings

Definition of maternal death

• The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

WHO International Statistical Classification of Diseases and Related Health Problems,

Tenth Revision, 1992 (ICD-10),

Maternal mortality ratio (MMR)

• The MMR is the…

Number of maternal deaths per 100,000 live births

MDG Target 5.A: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

Measurement challenges

• To accurately categorize a death as maternal information is needed regarding:– cause of death

– pregnancy status

– timing of death in relation to the pregnancy

• Large confidence intervals

Definitions

Methodological approach

Findings

Sources of maternal mortality data

• Maternal mortality data can come from a variety of sources:– Civil registration systems– Household surveys – Censuses– Reproductive-age mortality studies (RAMOS)

– Sisterhood methods– Verbal autopsies

Interagency approach to measuring

maternal mortality• Civil registration – data

adjusted and used directly for estimating MMR

• Lacking civil registration data – multilevel regression model developed using available national level data

Interagency approach to measuring

maternal mortality• Civil registration – data

adjusted and used directly for estimating MMR

• Lacking civil registration data – multilevel regression model developed using available national level data

% of countries in each category

Interagency approach to measuring

maternal mortality• Civil registration – data

adjusted and used directly for estimating MMR

• Lacking civil registration data – multilevel regression model developed using available national level data

% of countries in each category

Overview of the model

• Multilevel regression model (for 113 countries)

• Three covariates selected from larger list of potential indicators:– Gross domestic product per capita (GDP)– General fertility rate (GFR)– Skilled attendant at delivery (SAB)

Definitions

Methodological approach

Findings

Substantial geographic variation in MMRs

Approximately 9 in every 10 maternal deaths in sub-Saharan Africa or South Asia

Global distribution of maternal deaths, 2008

358,000 maternal

deaths worldwide

Maternal mortality is declining

Maternal mortality is declining

34% decline

MMRs decline across all developing regions

Maternal deaths per 100,000 live births

Conclusion• Substantial progress made:– 34% decline in developing world– 188,000 fewer deaths today than in 1990– 58 countries are making progress or on-track

• But more needs to be done– MDG target requires 5.5% annual decline, but

current rate is 2.3% to date– 358,000 maternal deaths, mostly preventable – Every year 45,000 births are not attended by

skilled health personnel

www.childinfo.org/maternal_mortality.html