Trends in Maternal Mor tality: 1990 to 2015

Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.

When the global commitment was first made in 2000 to achieve the Millennium Development Goals (MDGs), United Nations (UN) Member States pledged to work towards a three-quarters reduction in the 1990 maternal mortality ratio (MMR; maternal deaths per 100 000 live births) by 2015. This objective (MDG 5A), along with achieving universal access to reproductive health (MDG 5B), formed the two targets for MDG 5: Improve maternal health. In the years counting down to the conclusion of the MDGs, a number of initiatives were established to galvanize efforts towards reducing maternal mortality. These included the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, which mobilized efforts towards achieving MDG (Improve child health) as well as MDG 5, and the high-level Commission on Information and Accountability (COIA), which promoted “global reporting, oversight, and accountability on women’s and children’s health”. To build upon the momentum generated by MDG 5, a transformative new agenda for maternal health has been laid out as part of the Sustainable Development Goals (SDGs): to reduce the global MMR to less than 70 per 100 000 live births by 2030 (SDG 3.1). The recent World Health Organization (WHO) publication, Strategies toward ending preventable maternal mortality (EPMM), establishes a supplementary national target that no country should have an MMR greater than 140 per 100.000 live births, and outlines a strategic framework for achieving these ambitious targets by 2030.

Planning and accountability for improving maternal health, and assessment of MDG 5 and SDG targets, require accurate and internationally comparable measures of maternal mortality. Many countries have made notable progress in collecting data through civil registration systems, surveys, censuses and specialized studies over the past decade. This laudable increase in efforts to document maternal deaths provides valuable new data, but the diversity of methods used to assess maternal mortality in the absence of civil registration systems prevents direct comparisons among indicators generated. The 2011 COIA recommendations emphasized the need for countries to establish civil registration systems for recording births, deaths and causes of death. Insufficient progress has been made, as many countries still lack civil registration systems and where such systems do exist, underreporting continues to pose a major challenge to data accuracy. Looking ahead, one cross-cutting action towards EPMM is to “improve metrics, measurement systems and data quality to ensure that all maternal and newborn deaths are counted”.

Given the challenges of obtaining accurate and standardized direct measures of maternal mortality, the Maternal Mortality Estimation Inter-Agency Group (MMEIG) – comprising WHO, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), the World Bank Group, and the UN Population Division (UNPD) of the Department of Economic and Social Affairs – has been working together with a team at the University of Massachusetts Amherst, United States of America (USA), the National University of Singapore, Singapore, and the University of California at Berkeley, USA, to generate internationally comparable MMR estimates. An independent technical advisory group (TAG), composed of demographers, epidemiologists and statisticians, provides technical advice. The estimates for 1990–2015 presented in this report are the eighth in a series of analyses by the MMEIG to examine the global, regional and country progress of maternal mortality. To provide increasingly accurate estimates of MMR, the previous estimation methods have been refined to optimize use of country-level data.

Consultations with countries were carried out following the development of preliminary MMR estimates for the years 1990–2015. Consultations aimed to: give countries the opportunity to review the country estimates, data sources and methods; obtain additional primary data sources that may not have been previously reported or used in the analyses; and build mutual understanding of the strengths and weaknesses of available data and ensure broad ownership of the results. These consultations generated substantial additional data for inclusion in the estimation model, demonstrating widespread expansion of in-country efforts to monitor maternal mortality. Annex 1 presents a summary of the process and results of the 2015 country consultations.

This report presents global, regional and country-level estimates of trends in maternal mortality between 1990 and 2015. Chapter 2 describes in detail the methodology employed to generate the estimates. Chapter 3 provides the estimates and interpretation of the findings. Chapter 4 assesses performance in terms of MDG 5, discusses implications of the estimates for future efforts towards achieving SDG 3.1, and closes by underlining the importance of improved data quality for estimating maternal mortality. The annexes to this report present an overview of the definitions and common approaches for measuring maternal mortality, the sources of data for the country estimates, and MMR estimates for the different regional groupings for WHO, UNICEF, UNFPA, the World Bank Group and the UNPD.

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