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Maternal mortality on a decline, but challenges remain -Vani Manocha
-Down to Earth

An earlier report had said that India accounts for the maximum number of maternal deaths in the world — 17 per cent or nearly 50,000 of the 289,000

The number of women dying during pregnancy, childbirth or within six weeks after birth has fallen by 44 per cent since 1990, say United Nations agencies, including the World Bank.

A recently-released report has said that maternal deaths around the world dropped from about 532,000 in 1990 to an estimated 303,000 this year. This equates to an estimated global maternal mortality ratio (MMR) of 216 maternal deaths per 100,000 live births, down from 385 in 1990. 

“The MDGs triggered unprecedented efforts to reduce maternal mortality,” said Flavia Bustreo, WHO Assistant Director-General, Family, Women’s and Children’s Health. “Over the past 25 years, a woman’s risk of dying from pregnancy-related causes has nearly halved.  That’s real progress, although it is not enough. We know that we can virtually end these deaths by 2030 and this is what we are committing to work towards,” Bustreo added. 

Titled "Trends in Maternal Mortality: 1990 to 2015 – Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division", the report is the last in a series that has looked at progress under the Millennium Development Goals (MDGs). Talking about how the world is placed to handle the problem in next few years, Babatunde Osotimehin, executive director of United Nations’ Population Fund said, “Many countries with high maternal death rates will make little progress, or will even fall behind, over the next 15 years if we don’t improve the current number of available midwives and other health workers with midwifery skills.” 

The report further suggests that Those countries are Bhutan, Cabo Verde, Cambodia, Iran, Lao People’s Democratic Republic, Maldives, Mongolia, Rwanda and Timor-Leste. Despite this important progress, the MMR in some of these countries remains higher than the global average.

India leads with maximum maternal deaths

A UN report had earlier revealed that in 2013, India accounted for the maximum number of maternal deaths in the world — 17 per cent or nearly 50,000 of the 289,000. Nigeria was second with nearly 40,000. Maternal mortality ratio in India in the same year was 190 per 100,000 live births

In Bihar, a state among those with high MMR in India, it was found that sex determination tests and lack of ambulances are major reasons for maternal deaths in the state’s capital region. 

"India decreased its MMR by more than 68%, which is very significant," says Fadéla Chaib of World Health Organization (WHO). Chaib, however, warns that India will need to further accelerate its rate of decline and ensure that all women have access to care before, during, and after pregnancy. "To do this, it is not only about health care issues like making sure medical interventions are available but also improving the education of girls, avoiding early marriage, and ensuring gender equality. We should also not forget that ensuring that a wide range of contraceptive options is important to help women plan and space, and avoid pregnancies," she tells Down To Earth.

India will need to further accelerate its rate of decline and ensure that all women have access to care before, during, and after pregnancy. To do this, it is not only about health care issues like making sure medical interventions are available but also improving the education of girls, avoiding early marriage, and ensuring gender equality. We should also not forget that ensuring that a wide range of contraceptive options is important to help women plan and space, and avoid pregnancies. India should also continue its efforts to conduct special studies on maternal mortality, as it helps to provide data. All of these actions will help India reach its SDG on maternal mortality.

A ray of hope

The Sustainable Development Goals demand end of preventable deaths of newborns and children under five years of age by 2020, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-five mortality to at least as low as 25 per 1,000 live births. By the end of this year, about 99 per cent of the world’s maternal deaths will have occurred in developing regions, with Sub-Saharan Africa alone accounting for two in three (66 per cent) deaths. But that represents a major improvement:  Sub-Saharan Africa saw nearly 45 per cent decrease in MMR, from 987 to 546 per 100,000 live births between 1990 and 2015. But this also means that a lot more remains to be done in the next few years.

The greatest improvement of any region was recorded in Eastern Asia, where the maternal mortality ratio fell from approximately 95 to 27 per 100,000 live births (a reduction of 72 per cent). In developed regions, maternal mortality fell 48 per cent between 1990 and 2015, from 23 to 12 per 100,000 live births. 

Need for better data

Analysis suggests that efforts to strengthen data and accountability especially over the past years have helped fuel this improvement. However, much more needs to be done to develop complete and accurate civil and vital registration systems that include births, deaths and causes of death. Maternal death audits and reviews also need to be implemented to understand why, where and when women die and what can be done to prevent similar deaths, says the report.