Maternal mortality refers to deaths due to complications from pregnancy or childbirth. From 1990 to 2015, the global maternal mortality ratio declined by 44 per cent – from 385 deaths to 216 deaths per 100,000 live births, according to UN inter-agency estimates. This translates into an average annual rate of reduction of 2.3 per cent. While impressive, this is less than half the 5.5 per cent annual rate needed to achieve the three-quarters reduction in maternal mortality targeted for 2015 in Millennium Development Goal 5.
Every region has advanced, although levels of maternal mortality remain unacceptably high in sub-Saharan Africa. Almost all maternal deaths can be prevented, as evidenced by the huge disparities found between the richest and poorest countries. The lifetime risk of maternal death in high-income countries is 1 in 3,300, compared to 1 in 41 in low-income.
LEVELS OF MATERNAL MORTALITY
The number of women and girls who died each year from complications of pregnancy and childbirth declined from 532,000 in 1990 to 303,000 in 2015. These improvements are particularly remarkable in light of rapid population growth in many of the countries where maternal deaths are highest. Still, over 800 women are dying each day from complications in pregnancy and childbirth. And for every woman who dies, approximately 20 others suffer serious injuries, infections or disabilities. Almost all maternal deaths (99 per cent) occur in developing regions.
Two regions, sub-Saharan Africa and South Asia, account for 88 per cent of maternal deaths worldwide. Sub-Saharan Africans suffer from the highest maternal mortality ratio – 546 maternal deaths per 100,000 live births, or 201,000 maternal deaths a year. This is two thirds (66 per cent) of all maternal deaths per year worldwide. South Asia follows, with a maternal mortality ratio of 182, or 66,000 maternal deaths a year, accounting for 22 per cent of the global total. Furthermore, regional and global averages tend to mask large disparities both within and between countries.
CAUSES OF MATERNAL DEATH
Haemorrhage remains the leading cause of maternal mortality, accounting for over one quarter (27 per cent) of deaths. Similar proportion of maternal deaths were caused indirectly by pre-existing medical conditions aggravated by the pregnancy. Hypertensive disorders of pregnancy, especially eclampsia, as well as sepsis, embolism and complications of unsafe abortion also claim a substantial number of lives.
The complications leading to maternal death can occur without warning at any time during pregnancy and childbirth. Most maternal deaths can be prevented if births are attended by skilled health personnel – doctors, nurses or midwives – who are regularly supervised, have the proper equipment and supplies, and can refer women in a timely manner to emergency obstetric care when complications are diagnosed. Complications require prompt access to quality obstetric services equipped with life-saving drugs, including antibiotics, and the ability to provide blood transfusions needed to perform Caesarean sections or other surgical interventions.
Nearly all (99 per cent) of abortion deaths are due to unsafe abortions.
**This category includes deaths due to obstructed labour or anaemia.
Source: Source: Say L et al. 2014.
LIFETIME RISK OF MATERNAL DEATH
The lifetime risk of maternal death is the probability that a 15-year-old girl will die from complications of pregnancy or childbirth over her lifetime; it takes into account both the maternal mortality ratio and the total fertility rate (average number of births per woman during her reproductive years under current age-specific fertility rates). Thus, in a high-fertility setting, a woman faces the risk of maternal death multiple times, and her lifetime risk of death will be higher than in a low-fertility setting. Similar to maternal mortality ratio, the lifetime risk of maternal death varies largely across countries. In 2015, the lifetime risk of maternal death in low income countries as a whole was 1 in 41, compared to 1 in 3,300 in high-income countries. Among regions, women in sub-Saharan Africa face the highest lifetime risk (1 in 36), followed by South Asia (1 in 200).
*Income groups refer to World Bank income classification in 2015.
Source: WHO, UNICEF, UNFPA and The World Bank, Trends in Maternal Mortality: 1990 to 2015, WHO, Geneva, 2015.
AbouZahr, C., and T. Wardlaw, ‘Maternal Mortality at the End of the Decade: What signs of progress?’, Bulletin of the World Health Organization, vol. 79, no. 6, 2001, pp. 561─573.
Khan, Khalid S., et al., ‘WHO Analysis of Causes of Maternal Death: A systematic review’, Lancet, vol. 367, no. 9516, 1 April 2006, pp. 1066─1074.
Say L et al., ‘Global causes of maternal death: a WHO systematic analysis’ Lancet Global Health. http://dx.doi.org/10.1016/S2214-109X(14)70227-X, May 6, 2014.
UNICEF, Progress for Children: Achieving the MDGs with equity, Report No. 9, UNICEF, New York, 2011.
UNICEF, Progress for Children: A report card on maternal mortality, Report No. 7, UNICEF, New York, 2008.
UNICEF, WHO and UNFPA, Guidelines for Monitoring the Availability and Use of Obstetric Services, UNICEF, New York, 1997.
WHO and UNICEF, The Sisterhood Method for Estimating Maternal Mortality: Guidance notes for potential users, WHO, Geneva 1997.
WHO, UNICEF, UNFPA and The World Bank, Trends in Maternal Mortality: 1990 to 2015, WHO, Geneva, 2015.
Indicator and Monitoring Framework for the Global Strategy for Women’s, Children’s and Adolescents’ Health
This report presents the indicator and monitoring framework for the Global Strategy for Women’s, Children’s and Adolescents’ Health, (2016-2030) focusing on its Survive, Thrive and Transform objectives and 17 targets. The report details the selection process for the indicators and implications for monitoring, measurement, investments and reporting.
The Global Strategy (2016-2030) is a roadmap to achieve right to the highest attainable standard of health for all women, children and adolescents –to transform the future and ensure every newborn, mother and child not only survives, but thrives. The new Strategy – updated through a process of collaboration with stakeholders led by WHO – builds on the success of the 2010 Strategy and its Every Woman Every Child movement as a platform to accelerate the health-related Millennium Development Goals and puts women, children and adolescents at the heart of the new UN Sustainable Development Goals.
This summary presents new estimates of maternal mortality produced by the Maternal Mortality Estimation Inter-Agency Group (MMEIG) as part of global and country monitoring of the Millennium Development Goal five. The estimates for 1990 to 2015 presented in this summary are the eighth in a series of analyses by the MMEIG to examine global, regional and country progress in reducing maternal mortality.
The Ending Preventable Maternal Mortality (EPMM) targets and strategies are grounded in a human rights approach to maternal and newborn health, and focus on eliminating significant inequities that lead to disparities in access, quality and outcomes of care within and between countries. Concrete political commitments and financial investments by country governments and development partners are necessary to meet the targets and carry out the strategies for EPMM.
NOTES ON THE DATA
For detailed notes on maternal mortality data and estimation procedures please se: WHO, UNICEF, UNFPA and The World Bank, Trends in Maternal Mortality: 1990 to 2013, WHO, Geneva, 2014.