Maternal mortality: a cross-sectional study in global health

Background: This study reports the results of a secondary analysis of data provided by the World Health Organization to determine the correlates of maternal mortality among all reporting nations worldwide. Historically, maternal mortality ratios have declined in nations that provided a system for access to skilled care for the majority of its women. Currently, maternal mortality ratios are associated with access to skilled care as well as economic indicators, literacy, education, access to contraceptives, transportation and HIV prevalence. Methods: Descriptive statistics, bi-variate correlations and multiple linear regression analyses are reported using maternal mortality ratios as the dependent variable. In addition, an examination of countries that are exceptions to the regression is also reported. Results: Strong positive Pearson two-tailed correlations were found between MMR and infant mortality rate (0.866), total fertility rate (0.854), poverty rate (0.756), and adolescent fertility rate (0.710). Strong negative correlations were found between MMR and percentage of births attended by a skilled attendant (−0.786), percentage of women using contraceptives (−0.786), and adult literacy rate (−0.710). Eighty-one percent of the variation in MMR can be explained by differences in IMR, percent of births attended by a skilled provider, percent of women using contraceptive, total fertility rate, adolescent fertility rate, adult literacy rate and poverty. Discussion: Examination of the correlates of maternal mortality gives direction to the effort to achieve the WHO's Millennium Development Goal of reducing maternal mortality by two-thirds from 1995-2015.

International Journal of Gynecology & Obstetrics, 2012

Reducing maternal mortality within significant margins is a global imperative that reflects attainment of development goals. Progress in reducing maternal mortality, in particular among countries with notably high maternal mortality ratios (MMRs), has been substantially slower than the Millennium Development Goal target of an annual rate of 5.5% decline. The latest UN maternal mortality estimates show a reduction in MMR in a number of countries between 1990 and 2008. Understanding the factors associated with progress in countries that have reduced maternal mortality provides other countries and development partners with opportunities to consider and implement policies and interventions that could help accelerate progress. This paper reviews 6 countries that have demonstrated marked progress. The policies that have been effective include innovative financing measures; investment in human resources both in terms of strengthening preservice education and emphasizing in-service training for healthcare providers; strengthening obstetric care by enhancing infrastructure and upgrading equipment, as well as improving quality of services; and investing in the broader determinants of maternal mortality, particularly family planning and women's education and socioeconomic empowerment. This range of actions, which includes a combination of facility and community-based approaches, provides a list of potentially effective strategies that could be considered when developing programs in other countries with slower progress. Strong political will and multistakeholder involvement and interventions are key in the development and implementation of these policies and actions.

In 2015, the World Health Organization (WHO) released global targets and strategies for reducing maternal mortality in the Sustainable Development Goal (SDG) period developed through broad stakeholder consultations. The targets and strategies identified in the "Strategies toward Ending Preventable Maternal Mortality (EPMM)" report are grounded in a systemic and human rights approach to maternal health and aim to address the broad spectrum of key social, political, economic, and health system determinants of maternal health and survival, as exemplified by 11 Key Themes. These upstream determinants of maternal survival are not well represented in maternal health measurement efforts, which tend to focus on service delivery. Thus, work was undertaken to develop a core set of maternal health indicators that could drive progress toward achieving the recommendations laid out in the EPMM Strategies that identified a menu of 25 indicators and 7 standard stratifiers related to the legal and policy environment, accountability mechanisms, inequities in access and quality, and empowerment of women, girls, families, and communities. Measurement experts have called for more research to ensure that indicators for monitoring maternal health, including its upstream determinants, are valid, which is critical if such measures are to be effective for driving and tracking progress toward ending preventable maternal deaths. This paper describes nine research reports emanating from seven discrete research studies to validate ten indicators in India, Ghana and Argentina that are compiled in a PLOS Collection with the aim of illustrating the breadth of the validation work, extracting some unifying themes and common findings, and discussing the implications for policy and practice they suggest.

Reproductive Health Matters, 2009

This paper examines why progress towards Millennium Development Goal 5 on maternal health appears to have stagnated in much of the global south. We contend that besides the widely recognised existence of weak health systems, including weak services, low staffing levels, managerial weaknesses, and lack of infrastructure and information, this stagnation relates to the inability of most countries to meet two essential conditions: to develop access to publicly funded, comprehensive health care, and to provide the not-for-profit sector with needed political, technical and financial support. This paper offers a critical perspective on the past 15 years of international health policies as a possible cofactor of high maternal mortality, because of their emphasis on disease control in public health services at the expense of access to comprehensive health care, and failures of contracting out and public-private partnerships in health care. Health care delivery cannot be an issue both of trade and of right. Without policies to make health systems in the global south more publicly-oriented and accountable, the current standards of maternal and child health care are likely to remain poor, and maternal deaths will continue to affect women and their families at an intolerably high level.

Journal of Perinatal Medicine

Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management. Maternal mortality (MM) and morbidity are a public health issue, with scarce knowledge on their levels and causes in low-income (LIC) countries. The data on MM and morbidity should rely on population-based studies which are non-existent. Therefore, maternal mortality ratio (MMR) estimates are based mostly on the mathematical models. MMR declined from 430 per 100,000 live births (LB) in 1990 to 211 in 2017. Absolute numbers of maternal deaths were 585,000 in 1990, 514,500 in 1995 and less than 300,000 nowadays. Regardless of reduction, MM remains neglected tragedy especially in LIC. Millennium Development Goals (MDGs) declared reduction MMR by three quarters between 2000 and 2015, which failed. Target of Sustainable Development Goals (SDGs)...

PloS one, 2016

From 1990-2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. The model shows that respectively 100% and 89% of the reductions in maternal...

Donald School Journal of Ultrasound in Obstetrics and Gynecology

Aim: To present the data from United Nations 2005 and 2015 Millennium Development Goals (MDG) reports. Results: The World is faced with the increasing problem of inequality. That is why millennium declaration was signed in the year 2000. The United Nations millennium declaration embodies an agreement that developing countries will work to maintain sound economies, to ensure their own development and to address human and social needs. Developed countries, in turn, agree to support poorer countries through aid, trade, and debt relief. A meaningful partnership between rich and poor must also address developing countries' need for technology, medicines, and jobs for their populations, particularly for the growing ranks of young people. In this paper, two MDG reports from 2005 to 2015 were presented with the analysis of the reasons for which the targets of MDG were not met and how World

Objective: Evaluating the status of the ECO member countries in relation to goal 5 of 3rd millennium which includes 75% reduction of maternal mortality rate till 2015 in comparison to 1990. Material and Methods: In 2009, we have critically reviewed the countries' MDG reports and extracted the data on each MDGs' indicator by year and cause of mortality, (if possible) resident area (urban/rural) to explore the trend. In the next phase, the main stakeholders, from both governmental and international organizations in the country have been visited and interviewed (individually and in group) by the research team as part of the data validation process. Results: The MMR is very heterogeneous among the ECO countries. Afghanistan with the MMR of 1800 (per 100,000 live births) in 2005 is the worst country in the region/world while Turkey has reached the level of 19.4 maternal deaths per 100,000 live births in 2008. Multiple regression analysis shows that only the index of delivery by skilled health personnel is effective in reduction of maternal mortality. Conclusion: With considering half a decade to the end of predetermined time for achieving the millennium development goals, i.e. 2015, it's optimistically expected that only a few of the ECO countries will reach the target for maternal health.

2020

Maternal Mortality Rate(MMR) refers to deaths due to complications from pregnancy and/or childbirth. Complications of childbirth and pregnancy are predominant reasons of death among women of reproductive age across the world. Setting up of goals for mortality reduction is vital, but it we must also acknowledge the fact that accurate measurement of maternal mortality remains still challenging and many deaths still go uncounted or unnoticed. As per the data published by WHO, the WHO African region has got the highest Maternal Mortality Rate when compared it with its other five regions. In this paper we predict how Maternal Mortality Rate(MMR) is related to the following attributes GDP growth, Maternal Leave Policy, Literacy rate and Health care expenditure among the different regions of the world . As part of the predictions, Child Mortality Rate(CMR) is shown in relation with Maternal Mortality Rate(MMR); CMR among different age groups; Maternal mortality due to direct and indirect h...

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015.