Online-only: Worldwide maternal mortality on the decline, but much more work is needed
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* Kim Krisberg

While global maternal mortality numbers have dropped by nearly 200,000 in recent years, it is not enough to reach the Millennium Development Goal of reducing maternal death by 75 percent in 2015, according to a recent report.

From 1990 to 2008, the number of women dying due to complications during pregnancy and childbirth declined 34 percent, from 546,000 deaths in 1990 to 358,000 in 2008. The numbers average a yearly decline of just more than 2 percent, meaning the annual decline must grow to more than 5 percent to reach the Millennium Development Goal target, according to “Trends in Maternal Mortality: 1990 to 2008,” which was released in September by the World Health Organization, UNICEF, United Nations Population Fund and World Bank. In 2008, 1,000 women died every day due to four major causes — severe bleeding after childbirth, infection, hypertensive disorders and unsafe abortion — with the majority of such women living in sub-Saharan Africa, the report found.

“The global reduction in maternal death rates is encouraging news,” said WHO Director-general Margaret Chan, MD, MPH. “Countries where women are facing a high risk of death during pregnancy or childbirth are taking measures that are proving effective: they are training more midwives and strengthening hospitals and health centers to assist pregnant women. No woman should die due to inadequate access to family planning and to pregnancy and delivery care.”

Developing nations were home to almost all, or 99 percent, of maternal deaths, with 87 percent of such deaths happening in sub-Saharan Africa and south Asia, according to the report. In 2008, an estimated 42,000 such deaths were due to HIV/AIDS among pregnant women, with the highest HIV/AIDS-related maternal death rate in sub-Saharan Africa as well. Overall, from 1990 to 2008, 147 nations experienced a decline in maternal mortality, 90 experienced a decline of 40 percent or more, and 23 countries recorded an increase.

Among the many factors in the declining maternal mortality rate are improvements to national health systems, more contraceptive use, better education among young girls and women, and a rise in the number of deliveries attended by skilled health workers, which rose from 53 percent in developing regions in 1990 to 63 percent in 2008, the report found.

“The modest and encouraging progress in reducing maternal mortality is likely due to increased attention to developing and implementing policies and strategies targeting increased access to effective intervention,” the report said. “Such efforts need to be expanded and intensified to accelerate progress towards reducing the still very wide disparities between developing and developed worlds.”

Yves Bergevin, MD, MSc, a senior maternal health advisor at UNFPA and coordinator of the agency’s Maternal Health Thematic Fund, which supports activities in priority nations, said the bottom line is that “we need to more than double our rate of progress and accelerate it even further in some countries if we’re to approach the Millennium Development Goal.”

And it is possible, he said. For example, Ethiopia experienced a 53 percent decrease in maternal mortality from 1990 to 2008, with an annual rate of decline of more than 4 percent, while Rwanda experienced a 51 percent decrease in maternal mortality and an annual decline of almost 4 percent, Bergevin said.

“There is no doubt that when resource-poor countries set their minds to it and follow through on this in a very systematic fashion, that you can reduce maternal mortality rapidly even in the most resource-poor settings,” Bergevin told The Nation’s Health.

A number of conditions are needed to continue improving maternal mortality rates, Bergevin said, such as political commitment, removing financial barriers to care, strong public health systems, improving access to family planning services and ensuring every birth is attended by a skilled health professional. In fact, in June, health advocates from organizations such as WHO and UNFPA issued a global call to action to strengthen midwifery, noting that more than 300,000 midwives will be needed in the next few years to assist in countries with high maternal mortality rates.

Bergevin also called for better reporting and measurement techniques, emphasizing the need for real-time reporting of maternal deaths as well as consistent “maternal mortality audits so that we can learn why these occurred and how to avert these deaths in the future.”

“We have seen success stories from around the world that maternal mortality can be reduced,” he said. “But we need more midwives, more money and we need very sound national health plans and solid monitoring and evaluation.”

For more information on global maternal mortality or a copy of the recent report, visit [www.who.int](http://www.who.int).

*   Copyright The Nation’s Health, American Public Health Association