Maternal deaths decline slowly with vast inequalities worldwide
19 September 2019: A new report on maternal mortality, released today by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division, estimates a worldwide number of 295 000 maternal deaths in 2017. This figure represents a 38% reduction since the year 2000 an average reduction of just under 3% per year.
For women, this means that the global lifetime risk of maternal mortality – the risk that a 15-year old girl will die eventually from a maternal cause – was approximately 1 in 190 for 2017, nearly half of the level of risk in 2000.
"In countries that provide everyone with safe, affordable, high-quality health services, women and babies survive and thrive."
Dr Tedros Adhanom Ghebreyesus, Director-General of WHO
Vast inequalities worldwide
Not surprisingly, maternal deaths in the world’s least developed countries are high, estimated at 415 maternal deaths per 100 000 live births with the lifetime risk as high as 1 in 37 for a 15-year old girl in sub-Saharan Africa. In comparison, the same girl living in Australia or New Zealand would have a risk of just 1 in 7800.
Sub-Saharan Africa and Southern Asia accounted for approximately 86% (254 000) of the estimated global maternal deaths in 2017 with sub-Saharan Africa alone accounting for roughly 66% (196 000). Southern Asia accounted for nearly 20% (58 000) and South-Eastern Asia accounted for over 5% of global maternal deaths (16 000).
Regional and country-level trends, 2000–2017
Between 2000 and 2017, the subregion of Southern Asia achieved the greatest overall percentage reduction in its maternal mortality ratio (MMR, number of maternal deaths per 100,000 live births): 59% (from 384 to 157). This equates to an average annual rate of reduction of 5.3%. Four other subregions roughly halved their MMRs during this period: Central Asia (52%), Eastern Asia (50%), Europe (53%) and Northern Africa (54%). Despite its very high maternal mortality ratios, sub-Saharan Africa as a region also achieved a substantial reduction of roughly 38% since 2000. Notably, one subregion with very low MMR (12) in 2000 – Northern America – had an increase in MMR of almost 52% during this period, rising to 18 in 2017. This is likely related to already low levels of MMR, as well as improvements in data collection, changes in life expectancy and/or changes in disparities between subpopulations.
HIV related maternal deaths
There is good news in that the effect of HIV on maternal mortality in 2017 appears to be less pronounced than in earlier years; HIV-related indirect maternal deaths now account for approximately 1% of all maternal deaths compared with 2.5 % in 2005, at the peak of the epidemic.
"Despite the ambition to end preventable maternal deaths by 2030, at the current rate of progress, the world will tragically fall short of this target by more than 1 million lives."
Dr Doris Chou, WHO Medical Officer
The global challenge
The Sustainable Development Goals adopted a target of achieving a global maternal mortality ratio of less than 70 per 100 000 live births by 2030.
There is a continued urgent need for maternal health and survival to remain high on the global health and development agenda and to move beyond just survival. Achieving maternal health outcomes requires efforts to improve the accessibility and quality of care. The 2018 Declaration of Astana repositioned primary health care as the most (cost) effective and inclusive means of delivering health services to achieve the SDGs and is the cornerstone for achieving universal health coverage.
The need for high-quality data
Having targets for mortality reduction is important, but accurate measurement of maternal mortality remains challenging and many deaths still go uncounted despite widespread expansion of in-country efforts to monitor maternal mortality. Many countries still lack well-functioning civil registration and vital statistics systems, and where such systems do exist, reporting or misclassification of cause of death continue to pose a major challenge to data accuracy.