Maternal Mortality: Are We Making Progress?

According to latest estimates by the United Nations, the lifetime risk of pregnancy-related death for a woman in sub-Saharan Africa is 1 in 31 - strikingly higher than the 1 in 2,100 risk for a woman in the U.S.  While deaths during pregnancy or childbirth have declined by more than a third globally over the past 20 years (from 550,000 deaths in 1990 to 350,000 in 2008), the latest figures from the U.N. indicate that progress is still spotty.

Tanzanian woman receives antenatal care.

Anne Paxton, DrPH, associate professor of clinical epidemiology, along with her co-author, Mailman graduate Dr. Tessa Wardlaw of the Statistics and Monitoring Section, Division of Policy and Practice, UNICEFF, shares her views on the global improvements achieved in maternal mortalityshares her views on the global improvements achieved in maternal mortality in a New England Journal of Medicine Perspective, titled, “Are We Making Progress in Maternal Mortality?” She points out that while some countries have seen significant improvements, others report marked increases in maternal mortality, and the overall downward trend will not help us achieve the Millennium Development Goal (MDG) of a 75% reduction in maternal mortality by 2015.

Dr. Paxton, who also is also associate professor of Population and Family Health, notes that the complications that lead to death during pregnancy or childbirth are fairly common among all women, regardless of where they live. Hemorrhaging and hypertension disorders are common everywhere, but are significant causes of mortality only in developing countries due to lack of access to treatment.  On the other hand, obstetric fistula is just about nonexistent in the U.S. and developed world, and is a horrific complication of inadequate obstetrical care for obstructed labor.

While East Asia and the Pacific region have experienced the greatest decreases in maternal mortality, Sub-Saharan Africa, which has weaker health systems, has not realized the same improvement. Not surprisingly, data from all regions of the world - the U.S. included – indicate higher rates of death are found among the most economically disadvantaged women, with 20% of the poorest households least likely to deliver babies with help from skilled health personnel.

“Where does all this leave us?” asks Dr. Paxton. Should we be celebrating the global improvements in maternal mortality or be criticized for not meeting the Millennium Development Goals for maternal health?  On the one hand, we have made substantial investments to maternal mortality which led to an overall rate of decline in global maternal mortality (2.3%) but it is considerably lower than the 5.5% MDG target.

Dr. Paxton remains optimistic: “Continued focus on planning to make pregnancy and delivery safer and to improve treatment of obstetrical complications, especially among disadvantaged women, including those with HIV, will accelerate progress over the next decade.”