Last week the UN released its latest estimates on global maternal deaths, just two years after the last assessment. From 1990 to 2010, the UN found, the number of women dying from pregnancy- and childbirth-related causes worldwide dropped from 543,000 to 287,000, a near-fifty percent reduction in fatalities. The UN also finds that:
- Sub-Saharan Africa continues to have the highest maternal mortality ratio in the world, with a woman in the region facing a 1 in 39 lifetime risk of dying due to pregnancy or childbirth-related complications.
- Ten countries shoulder 60 percent of the global maternal mortality burden, some of them notably “middle income” and emerging global giants: India, Nigeria, Democratic Republic of Congo, Pakistan, Sudan, Indonesia, Ethiopia, Tanzania, Bangladesh, and Afghanistan.
- Ten countries have already reached the MDG 5 target of a 75 percent reduction in maternal death: Belarus, Bhutan, Equatorial Guinea, Estonia, Iran, Lithuania, Maldives, Nepal, Romania and Viet Nam.
The is great news, as it was two years ago, when both the UN and the Institute for Health Metrics and Evaluation (IHME) released data suggesting a considerable drop in maternal deaths in the recent decades. IHME updated their own figures last year, suggesting that in 2011, just 273,500 maternal deaths occurred.
This latest data falls in line with what much of the global community has suspected – progress is occurring, though still not at the pace at which it must. These latest numbers makes the picture clearer, though still not clear. Generally spotty data registry systems, for births, illnesses, or deaths, coupled with the large proportion of deaths that take place in rural and remote areas mean that these numbers are vague estimates at best. When a woman dies in pregnancy or childbirth, it may not be captured as a maternal death, and perhaps not captured at all. While it is not the case with all maternal deaths, in societies where women’s health and rights are devalued, their deaths are often not counted.
Another bugaboo in global maternal mortality data is the role of unsafe abortion.
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Unsafe abortion remains a persistent epidemic in developing countries, where 99 percent of maternal deaths occur. Restrictive abortion laws and/or lack of knowledge or access to safe services put women at grave danger. The stigma of abortion means that an abortion-related death will often not be catalogued as such, though the WHO considers it a leading cause of maternal mortality.
Earlier this year, the Guttmacher Institute released a report showing that while global abortion numbers seem to be down, the number of unsafe abortions happening worldwide are on the rise. Surely this should be reflected in maternal deaths – though may not be immediately for several reasons. The unmet need for contraception around the globe – more than 215 million women – almost certainly contributes to the rate of unsafe abortion, and maternal deaths more broadly.
The two leading causes of maternal mortality – excessive bleeding after childbirth and hypertension that can lead to fatal seizures – can both be treated fairly easily with cheap drugs already available in developing country markets. This is the “close but no cigar” burden under which maternal health advocates are operating: it’s not that we don’t know how to save women, or even that we do not have the means. It’s making the final link, between intention and action, or between availability and access, that remains unfortunately elusive.
The deadline for the Millennium Development Goals (MDGs) is 2015, and MDG 5, calls for improvements in maternal health. Progress has been impressive in some countries, especially where access to contraception has been prioritized, and front-line health workers – or the roll out of basic trained health providers such as midwives – have been supported.
There are clear models of what is working and what isn’t, and as the numbers roll in, it’s up to the maternal health – and broader development community – to assess this and move swiftly before more lives are lost. Maternal deaths are significant losses not just for a family, but for an entire community and nation, with economic, social, and health implications that reach out much farther than we often realize.