The recent report on MMR estimates for 2013 that was released by the UN agencies – Trends in Maternal Mortality: 1990 to 2013 – shows a 45% decline in global maternal deaths between 1990 and 2013. The burden and risk of maternal death remains the highest in sub-Saharan Africa and South Asia with these regions accounting for 62% and 24% of the deaths, respectively. Whilst absolute numbers show that India and Nigeria account for one third of all global maternal deaths, country level MMR estimates show that Sierra Leone records the highest (1100), and Chad and Somalia have the highest lifetime risk of maternal death. Giving birth is becoming safer, but not yet at the rate at which it should to meet the MDG targets in several countries. The report attributes this progress to “leadership and partnership, evidence and innovation, development and implementation of dual short-term and long-term strategies, and adaptation to change.”
A key challenge this report highlights has to do with measuring maternal mortality. According to the report, “Less than 40% of countries have a complete civil registration system with good attribution of cause of death, which is necessary for the accurate measurement of maternal mortality”. Three issues could affect measurement –deaths of women of reproductive age not being recorded at all; even when deaths are recorded, pregnancy status or cause of death being unknown and deaths therefore not being reported as maternal deaths; or difficulties in attributing a woman’s death as a maternal death due to lack of medical certification or misclassification on the ICD -10 coding. Current estimates therefore have to statistically adjust for such lapses. This report presents re-estimated figures for previous years using the same approach as it has used in previous years, but with updated data from existing countries and data from two additional countries, so that the trends across years and countries are comparable. A profile for each country including a graph of the MMR trend and the source of data used in the estimation can be found on the WHO website. Maternal death reviews therefore are an important tool for counting deaths, capturing the details on cause of death and more importantly, to help “initiate necessary actions to prevent deaths.” And as the report points out “implementation of the MDSR system should help to accelerate progress towards MDG 5 and make maternal deaths rare events beyond 2015”.
Trends in maternal mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division, May 2014