Transcript ESA/STAT/AC.219/16 Trends in maternal mortality 1990-2008 Holly Newby Statistics and Monitoring Section UN inter-agency estimates for 2008 Released SeptemberIncludes trends for 172 countries.

ESA/STAT/AC.219/16
Trends in
maternal mortality
1990-2008
Holly Newby
Statistics and Monitoring Section
UN inter-agency estimates for 2008
Released September
2010
Includes trends for
172 countries
Maternal Mortality Estimation
Inter-agency Group (MMEIG)
The 2008 UN inter-agency estimates were
produced by the Maternal Mortality
Estimation Inter-agency Group (MMEIG):
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WHO
UNICEF
UNFPA
The World Bank
Technical Advisory Group
Definitions
Methodological approach
Findings
Definitions
Methodological approach
Findings
Definition of maternal death
• The death of a woman while pregnant or
within 42 days of termination of pregnancy,
irrespective of the duration and site of the
pregnancy, from any cause related to or
aggravated by the pregnancy or its
management but not from accidental or
incidental causes.
WHO International Statistical Classification of
Diseases and Related Health Problems,
Tenth Revision, 1992 (ICD-10),
Maternal mortality ratio (MMR)
• The MMR is the…
Number of maternal deaths
per 100,000 live births
MDG Target 5.A: Reduce by three-quarters,
between 1990 and 2015, the maternal
mortality ratio
Measurement challenges
• To accurately categorize a death as maternal
information is needed regarding:
– cause of death
– pregnancy status
– timing of death in relation to the pregnancy
• Large confidence intervals
Definitions
Methodological approach
Findings
Sources of maternal mortality data
• Maternal mortality data can come from a
variety of sources:
– Civil registration systems
– Household surveys
– Censuses
– Reproductive-age mortality studies (RAMOS)
– Sisterhood methods
– Verbal autopsies
Interagency approach to measuring
maternal mortality
• Civil registration – data
adjusted and used directly
for estimating MMR
• Lacking civil registration data
– multilevel regression model
developed using available
national level data
Interagency approach to measuring
maternal mortality
• Civil registration – data
adjusted and used directly
for estimating MMR
37%
63%
• Lacking civil registration data
– multilevel regression model
developed using available
national level data
% of countries in each category
Interagency approach to measuring
maternal mortality
• Civil registration – data
adjusted and used directly
for estimating MMR
14%
37%
49%
• Lacking civil registration data
– multilevel regression model
developed using available
national level data
% of countries in each category
Overview of the model
• Multilevel regression model (for 113 countries)
• Three covariates selected from larger list of
potential indicators:
– Gross domestic product per capita (GDP)
– General fertility rate (GFR)
– Skilled attendant at delivery (SAB)
Definitions
Methodological approach
Findings
Substantial geographic variation
in MMRs
Approximately 9 in every 10 maternal deaths in
sub-Saharan Africa or South Asia
358,000
maternal
deaths
worldwide
Industr.
1,600
<1%
CEE/CIS
1,900
1%
EAP,
27000
8%
Sub-Saharan
Africa,
204,000
57%
LAC,
9,200
3%
South Asia,
109,000
31%
Global distribution of
maternal deaths, 2008
Maternal mortality is declining
Least developed
countries
900
590
Developing
countries
Industrialized
countries
World
440
290
12
14
400
260
1990
2008
Maternal deaths per 100,000 live births
Maternal mortality is declining
Least developed
countries
900
590
Developing
countries
Industrialized
countries
World
440
34%
decline
290
12
14
400
260
1990
2008
Maternal deaths per 100,000 live births
MMRs decline
across all developing regions
1990
2008
900
870
640
610
590
440
290
290
270
170
South Asia
Middle East/North
Africa
260
200
140
88
Sub-Saharan Africa
400
East Asia/Pacific
Maternal deaths per 100,000 live births
85
Latin
America/Caribbean
69
34
CEE/CIS
Developing countries Least developed
countries
World
Conclusion
• Substantial progress made:
– 34% decline in developing world
– 188,000 fewer deaths today than in 1990
– 58 countries are making progress or on-track
• But more needs to be done
– MDG target requires 5.5% annual decline, but
current rate is 2.3% to date
– 358,000 maternal deaths, mostly preventable
– Every year 45,000 births are not attended by
skilled health personnel
www.childinfo.org/maternal_mortality.html