Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group

Leontine Alkema, Doris Chou, Daniel Hogan, Sanqian Zhang, Ann-Beth Moller, Alison Gemmill, Doris Ma Fat, Ties Boerma, Marleen Temmerman, Colin Mathers, Lale Say, United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group, Saifuddin Ahmed, Mohamed M Ali, Agbessi Amouzou, David Braunholtz, Peter Byass, Liliana Carvajal-Velez, Victor Gaigbe-Togbe, Patrick Gerland, Edilberto Loaiza, Samuel Mills, Namuunda Mutombo, Holly Newby, Thomas W Pullum, Emi Suzuki, Leontine Alkema, Doris Chou, Daniel Hogan, Sanqian Zhang, Ann-Beth Moller, Alison Gemmill, Doris Ma Fat, Ties Boerma, Marleen Temmerman, Colin Mathers, Lale Say, United Nations Maternal Mortality Estimation Inter-Agency Group collaborators and technical advisory group, Saifuddin Ahmed, Mohamed M Ali, Agbessi Amouzou, David Braunholtz, Peter Byass, Liliana Carvajal-Velez, Victor Gaigbe-Togbe, Patrick Gerland, Edilberto Loaiza, Samuel Mills, Namuunda Mutombo, Holly Newby, Thomas W Pullum, Emi Suzuki

Abstract

Background: Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030.

Methods: We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources.

Results: We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%.

Interpretation: Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths.

Funding: National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Conflict of interest statement

Conflict of interest statement

We declare that we have no conflicts of interest.

Copyright © 2016 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1. Global and regional MMR estimates…
Figure 1. Global and regional MMR estimates (per 100,000 live births) from 1990 to 2015
Shaded areas refer to 80% UIs. Note: y-axes differ; grey shaded areas in background are comparable across graphs.
Figure 2. Maternal mortality ratio (per 100,000…
Figure 2. Maternal mortality ratio (per 100,000 live births) for 2015 by country
A: point estimates, B: lower bounds of 80% UIs, C: upper bounds of 80% UIs
Figure 3. Relative reduction from 1990 to…
Figure 3. Relative reduction from 1990 to 2015 for 95 countries with MMR >100 in 1990
Countries are grouped based on the categories from Table 6, where LB refers to lower bound of the 80% UI. Within each category, countries are sorted by the point estimate of the relative reduction. Horizontal lines refer to 80% UIs, such that there is a 1 in 10 chance that the relative reduction is greater than the reported upper bound and there is a 1 in 10 chance that the relative reductions is smaller than the reported lower bound. Abbreviations of country names: DRC = Democratic Republic of the Congo, OPT = Occupied Palestinian Territory.
Figure 4
Figure 4
Life time risk (*1,000) of a maternal death 1990 and 2015, globally and by region.

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Source: PubMed

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