Article

Estimates of maternal mortality worldwide between 1990 and 2005: An assessment of available data

Harvard Center for Population and Development Studies, Cambridge, MA 02138, USA.
The Lancet (Impact Factor: 45.22). 10/2007; 370(9595):1311-9. DOI: 10.1016/S0140-6736(07)61572-4
Source: PubMed

ABSTRACT

Maternal mortality, as a largely avoidable cause of death, is an important focus of international development efforts, and a target for Millennium Development Goal (MDG) 5. However, data weaknesses have made monitoring progress problematic. In 2006, a new maternal mortality working group was established to develop improved estimation methods and make new estimates of maternal mortality for 2005, and to analyse trends in maternal mortality since 1990.
We developed and used a range of methods, depending on the type of data available, to produce comparable country, regional, and global estimates of maternal mortality ratios for 2005 and to assess trends between 1990 and 2005.
We estimate that there were 535,900 maternal deaths in 2005, corresponding to a maternal mortality ratio of 402 (uncertainty bounds 216-654) deaths per 100,000 livebirths. Most maternal deaths in 2005 were concentrated in sub-Saharan Africa (270,500, 50%) and Asia (240,600, 45%). For all countries with data, there was a decrease of 2.5% per year in the maternal mortality ratio between 1990 and 2005 (p<0.0001); however, there was no evidence of a significant reduction in maternal mortality ratios in sub-Saharan Africa in the same period.
Although some regions have shown some progress since 1990 in reducing maternal deaths, maternal mortality ratios in sub-Saharan Africa have remained very high, with little evidence of improvement in the past 15 years. To achieve MDG5 targets by 2015 will require sustained and urgent emphasis on improved pregnancy and delivery care throughout the developing world.

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    • "A joint statement from the World Health Organization, the United Nations Population Fund, the United Nations Children's Fund, and the World Bank acknowledged, " [T]he settings where the problem of maternal mortality is most acute are precisely those where it is least likely to be accurately measured " (WHO, 1999, p. 10). Health systems may not always have an adequate monitoring and information system to track maternal deaths (Hill et al., 2007; Prata et al., 2011). The high-level Commission on Information and Accountability for Women's and Children's Health recommended that by 2015, all countries " have well-functioning health information systems that combine data from facilities, administrative sources, and surveys " (2011, p.2) in order to effectively improve maternal and child health and reduce mortality. "

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    • "seen in the Table 4, the majority of the innovations are for improving institutional deliveries or intranatal care, while overlooking other aspects of maternal healthcare including antenatal and postnatal care. Family planning services are an important part of maternal healthcare services -it reduces the lifetime risk of maternal death by reducing numbers of conceptions and by spacing births.[15]There is a dearth of innovations to address the issue of lower use of spacing methods and postponement of first birth, which can also reduce maternal deaths. Lack of comprehensive maternal healthcare services is a major drawback of all the maternal health programs implemented in India. "

    Full-text · Dataset · Jan 2016
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    • "seen in the Table 4, the majority of the innovations are for improving institutional deliveries or intranatal care, while overlooking other aspects of maternal healthcare including antenatal and postnatal care. Family planning services are an important part of maternal healthcare services -it reduces the lifetime risk of maternal death by reducing numbers of conceptions and by spacing births.[15]There is a dearth of innovations to address the issue of lower use of spacing methods and postponement of first birth, which can also reduce maternal deaths. Lack of comprehensive maternal healthcare services is a major drawback of all the maternal health programs implemented in India. "
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    ABSTRACT: India is the second most populous country and the highest contributor of maternal deaths globally. The maternal mortality ratio of India has been reduced from 400 in 1999 to 178 in 2012, a drop of more than 50% as per Sample Registration System (SRS), India report. Despite this decrease, India will not be able to achieve the fifth Millenium Development Goal (MDG 5) by 2015, and the magnitudeof decrease in maternal mortality has remained same for the past decade. India has implemented national level programs to improve maternal health starting with Child Survival Safe Motherhood (CSSM) in the 1990s, to the recent National Rural Health Mission (NRHM) implemented in 2005 which has led to some improvement in maternal healthcare utilization despite as documented in demographic surveys. The coverage of antenatal care has improved, with about 75% of all mothers receiving some antenatal care in 2007-08 compared to 65% in 1998-99. Similarly, institutional deliveries rose to 50% in 2008 from 34% in 1999. This chapter analyses the trends in maternal mortality in India, the maternal healthcare-delivery system at different levels, and the implementation of national maternal health programmes, including recent innovative strategies. It identifies the causes for limited success in improving maternal health indicators and suggests future actions to improve the situation. Geographical vastness and enormous sociocultural diversity mean that maternal mortality and maternal health care utilization varies across India, and uniform implementation of health-sector reforms is not possible. Improved documentation of maternal healthcare utilization and maternal health indicators including maternal deaths is recommended. Implementation of evidence-based, focused strategies along with effective monitoring is important for making meaningful difference in improving maternal health care utilization along with building a strong health system to make sustainable progress in maternal mortality reduction.
    Full-text · Chapter · Oct 2015
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