MDG 5: Improve Maternal Health

The 5th Millennium Development Goal (MDG5) is to reduce by three quarters the maternal mortality ratio and to achieve universal access to reproductive health. Approximately 358,000 women die during pregnancy and childbirth each year and millions more experience severe adverse consequences and illness. While the world is making encouraging progress in reducing deaths due to pregnancy and childbirth, maternal mortality remains unacceptably high across much of the developing world and efforts must be expanded and accelerated if MDG5 is to be achieved.

To this end, the United Nations 2010 Summit on the MDGs launched The Global Strategy for Women’s and Children’s Health: to reach Every Woman Every Child by 2015. This month, The Partnership for Maternal, Newborn & Child Health (PMNCH) released The Delhi Declaration 2010, which affirms this Global Strategy and commits governments and key stakeholders to transform the strategy into action using priority evidence-based interventions articulated into national plans and implemented equitably at scale through the continuum of care. In the U.S., saving maternal lives is part of the administration’s Global Health Initiative (GHI) and women’s reproductive rights have become part of U.S. foreign policy. Mechanisms for accelerating efforts to reach MDG 5 are being ramped up. There is much to do in the next 5 years.

According to the WHO’s Trends in Maternal Mortality: 1990 to 2008, the maternal mortality ratio (MMR) has declined by only 2.3% worldwide (far short of the 5.5% annual decline required to achieve MDG5) reaching an MMR of 260 deaths per 100,000 live births. Nearly 99% of these maternal deaths occur in developing regions, with sub-Saharan Africa bearing the greatest burden (MMR of 640) followed by South Asia (MMR of 280). While exciting progress has been made in some countries, progress in others is difficult to achieve—65% of maternal deaths are now concentrated in 11 countries. In sub-Saharan Africa, a woman’s risk of dying from treatable or preventable complications of pregnancy and childbirth over the course of her lifetime is 1 in 22, compared to 1 in 7,300 in the developed regions.

More than half the maternal deaths in developing countries are due to heavy bleeding after childbirth and hypertension. Obstructed labor and other complications at childbirth are responsible for 11% of the deaths, while indirect causes such as malaria and HIV/AIDS cause 18% of deaths overall, although in some countries this proportion is much higher. Most of these deaths can be prevented if the woman receives appropriate interventions from a skilled health worker with adequate equipment, drugs, and medicines. Data show that 67% of women in developing countries receive care from a trained provider four or more times during their pregnancies and that 63% of pregnant women in developing countries receive assistance from a skilled health worker during delivery, although wide disparities exist with 34% of women in rural regions getting recommended care and 46% of deliveries in sub-Saharan Africa being attended by a skilled health provider. In sub-Saharan Africa, only 22% of women aged 15-49 who are married or in union are using any method of contraception. Enhanced access to contraceptives could improve maternal health and reduce maternal deaths.

To accelerate progress in reaching MDG5 and related MNCH goals, the Global Strategy stresses the need for countries to work together to provide a comprehensive integrated package of essential quality interventions delivered by functional health care systems. Health systems need to be strengthened and shortages of skilled motivated health workers need to be addressed so that women have access to family planning, safe abortion care, antenatal care, delivery care, and postpartum care as outlined in the WHO packages of interventions for MNCH. In addition, multi-sectorial approaches are needed to address the root causes of maternal mortality and morbidity, such as poverty, malnutrition, lack of information and education, lack of access to health and family planning services, gender inequality, and violence.

I personally have participated in MNCH program evaluations in four countries in Africa and South Asia. The table below shows the mixed progress with MDG5 from 1990 to 2008 across these countries. Why the difference? It is most likely linked to the level of development and implementation of the strategies listed above.

Maternal Mortality Rate* Level of progress
1990 2008
India 570 230 Making progress
Bangladesh 870 340 Making progress
Nigeria 1110 840 Insufficient progress
Sierra Leone 1300 970 Insufficient progress
*maternal deaths per 100,000 live births

Grace Kreulen

This entry was posted on Thursday, November 18th, 2010 at 2:40 pm and is filed under Millennium Development Goals, Technical Updates. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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