The latest maternal mortality figures are in, and the news is mixed. According to a new United Nations report, Trends in Maternal Mortality: 1990 to 2013, trends in maternal mortality are improving. The global maternal mortality ratio (MMR) has fallen by 45 percent since 1990, with every region of the world experiencing a decline by at least 37 percent. That means the world went down from 380 maternal deaths per 100,000 live births in 1990 to 210 per 100,000 in 2013.
Progress is undeniable, but it is sadly not enough to meet the maternal health Millennium Development Goal Target 5A of reducing the global MMR by 75 percent by 2015. Moreover, global figures hide huge disparities between and within countries.
There were an estimated 289,000 maternal deaths globally in 2013; 62 percent of which occurred in Sub-Saharan Africa, followed by 24 percent in Southern Asia. In fact, India and Nigeria account for one-third of these deaths. In 2013, maternal deaths were largely caused by hemorrhage and indirect causes such as previously existing disease (like diabetes or high blood pressure).
Maternal mortality is thus still 14 times higher in the developing world than in the developed world; the top 12 countries with the highest maternal mortality in 2013 were all in Sub-Saharan Africa.
The report emphasized the absence of sound vital statistics registries in many countries. Despite the positive trends noted above, it is likely there are large numbers of maternal deaths that are either misclassified or underreported. In fact, the true number of maternal deaths could be twice as high as estimated.
Data remains incomplete and of poor quality, forcing researchers to model possibilities with wide margins of error. The WHO estimates that 7.9 percent of maternal deaths from 2003 to 2009 were due to unsafe abortion. This appears to be a steep drop from the WHO’s previous 13 percent estimate. But is it? In reality, deaths resulting from unsafe abortion frequently go unreported, or they are misclassified as caused by hemorrhage or sepsis. Maternal mortality from unsafe abortion is most likely higher, especially in regions where abortion laws are restrictive and the numbers of unsafe abortions are consequently high. In such regions, like Sub-Saharan Africa and Latin America and the Caribbean, the WHO currently estimates the proportion of maternal deaths due to unsafe abortion are 9.6 percent and 9.9 percent respectively, but these numbers could be higher. Without true figures, governments may not be compelled to improve this neglected, yet critical cause of maternal mortality and morbidity.
Notably, the report states unequivocally that where countries reframed basic health needs as human rights, maternal health improved. For example, Nepal reduced MMR by 76 percent after taking a human rights-based approach to their maternal health policies and strategies. This approach is based on seven key principles: availability, accessibility, acceptability and quality of facilities of services, participation, equality and non-discrimination, and accountability. In 2002 Nepal liberalized its abortion law and began offering abortion services in public hospitals. In addition, the report noted that political will, innovation, and implementation of evidence-based strategies were common to countries that managed to achieve MDG Target 5A, such as Cambodia and Rwanda.
As negotiations on the post-2015 development agenda proceed at the UN, IWHC and its allies are calling for any goal on health to ensure the right to the highest attainable standard of health, including sexual and reproductive health and rights. This should encompass a guarantee of access to safe abortion, contraception, maternity care, prevention and treatment of sexually-transmitted infections and HIV, and services for those who have experienced sexual violence. Access to these rights free of coercion, discrimination, and violence will guarantee a significant decline in preventable maternal mortality.
Infographic courtesy of the World Health Organization.