PHA-Exch> MATERNAL MORTALITY DECLINING IN MIDDLE-INCOME COUNTRIES; WOMEN STILL DIE IN PREGNANCY AND CHILDBIRTH IN LOW-INCOME COUNTRIES

[Claudio Schuftan]

From: Vern Weitzel vern at coombs.anu.edu.au
 "[health-vn discussion group]" <health-vn at cairo.anu.edu.au>

The world's maternal mortality ratio (the number of maternal
deaths per 100,000 live births) is declining too slowly to meet
Millennium Development Goal (MDG) 5, which aims to reduce the number
of women who die in pregnancy and childbirth by three quarters by 2015.

While an annual decline of 5.5 per cent in maternal mortality ratios
between 1990 and 2015 is required to achieve MDG 5, figures released
today by WHO, UNICEF, UNFPA and The World Bank show an annual decline
of less than 1 per cent. In 2005, 536,000 women died of maternal
causes, compared to 576,000 in 1990. Ninety-nine per cent of these
deaths occurred in developing countries.

The maternal mortality ratio in 2005 was highest in developing
regions, with 450 maternal deaths per 100,000 live births, in stark
contrast to 9 in developed regions and 51 in the countries of the
Commonwealth of Independent States (CIS). Moreover, the small drop in
the global maternal mortality ratio reflects mainly the declines that
have taken place in countries with relatively low levels of maternal
mortality. Countries with the highest initial levels of mortality have
made virtually no progress over the past 15 years.

The new maternal mortality estimates show that while gains are being
made in middle-income countries, the annual decline between 1990 and
2005 in sub-Saharan Africa was only 0.1 per cent. No region achieved
the necessary 5.5 per cent annual decline during the same period,
although Eastern Asia came closest to the target with a 4.2 per cent
annual decline and Northern Africa, South-Eastern Asia and Latin
America and the Caribbean experienced relatively faster declines than
sub-Saharan Africa.

Slightly more than one half of the maternal deaths (270,000) occurred
in the sub-Saharan Africa region, followed by South Asia (188,000).
Together, these two regions accounted for 86 per cent of the world's
maternal deaths in 2005.

Eleven countries accounted for almost 65 per cent of global maternal
deaths in 2005. India had the largest number (117,000), followed by
Nigeria (59,000), the Democratic Republic of the Congo (32,000) and
Afghanistan (26,000),

The probability that a 15-year-old girl will die from a complication
related to pregnancy and childbirth during her lifetime is highest in
Africa: 1 in 26. In the developed regions it is 1 in 7,300. Of all 171
countries and territories for which estimates were made, Niger had the
highest estimated lifetime risk of 1 in 7.

The maternal mortality ratio indicates the risk of death a woman faces
with each pregnancy. In settings with high fertility, such as
sub-Saharan Africa, women face this risk many times in their lifetime.

To achieve MDG 5 and reduce the maternal mortality ratio by three
quarters before 2015, improving health care for women and providing
universal access to reproductive health services must be prioritized.
This includes access to family planning, prevention of unplanned
pregnancies and provision of high-quality pregnancy and delivery care,
including emergency obstetric care.

However, health services can only help when women are able to make use
of them. When obstetric emergencies arise during pregnancy and
delivery, the importance of recognizing danger signs and seeking care
quickly is critical. Transportation must be available, and
appropriately staffed and equipped facilities must be within reach.
Increasing female education, improving gender equality, and
strengthening empowerment for making decisions about seeking care are
essential elements of strategies to reduce maternal mortality.
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