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% 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%. In 2005, 536 000 women died of maternal causes, compared to 576 000 in 1990. 99% 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 nine 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.
Annual decline rate below target
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%. No region achieved the necessary 5.5% annual decline during the same period, although Eastern Asia came closest to the target with a 4.2% 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% of the world’s maternal deaths in 2005.
Eleven countries accounted for almost 65% 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 7300. Of all 171 countries and territories for which estimates were made, Niger had the highest estimated lifetime risk of 1 in 7.
Indicator of death risk during pregnancy
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.