Maternal deaths: not stalled but 'persistently' improving

Carolyn Moynihan
15 Apr 2010
Reproduced with Permission

The number of women dying in childbirth, widely believed to be stalled at around half a million worldwide, has actually fallen by one third over the past three decades, according to research published in The Lancet this week.

As recently as last May the World Health Organisation said that mothers and newborns are no more likely to survive now than 20 years ago. But others have pointed out that there is a lot of guesswork in the statistics used to estimate maternal deaths.

Now, Dr Christopher Murray of the Institute of Health Metrics and Evaluation at the University of Washington (in Seattle) and his colleagues at the University of Queensland (Australia) estimate that such deaths dropped from 526,300 in 1980 to342,900 in 2008 -- a drop of 35 per cent. The researchers "took every bit of data they could find on deaths of women from records in 181 countries and plugged them into a computer model," reports Reuters. The study was paid for by the Bill and Melinda Gates Foundation.

"The overall message, for the first time in a generation, is one of persistent and welcome progress," said Lancet editor Richard Horton.

Not everyone involved in this issue is equally happy. The New York Times reports that some "advocates for women's health" wanted Lancet to delay publication of the "good news" until some key meetings had been held this year, fearing that it would affect funding. Dr Horton thinks they are misguided, and that evidence of progress will boost finding. Hmmm.

Back to the study -- the Times summarises:

The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of "skilled attendants" � people with some medical training � to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.

Also from the Times:

Among poor countries with longstanding high death rates, progress varied considerably. For instance, from 1990 to 2008, the maternal death rate dropped 8.8 percent a year in the Maldives, but rose 5.5 percent in Zimbabwe. Sub-Saharan Africa has the highest maternal death rates. Brazil improved more than Mexico, Egypt more than Turkey. Six countries accounted for more than half of all the maternal deaths in 2008: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo.

But India has made steady progress, and because its population is so large, its improvements have helped considerably to decrease the worldwide rate of maternal deaths. China has also made considerable progress. In India, there were 408 to 1,080 maternal deaths per 100,000 live births in 1980, and by 2008, there were 154 to 395, the new study found. In China, there were 144 to 187 deaths per 100,000 live births in 1980, and 35 to 46 in 2008.

Dr. Murray said the findings came as a surprise. What also surprised him and his colleagues, he said, was the number of pregnant women who died from AIDS: about 60,000.

"Really to a large extent that's why maternal mortality is rising in eastern and southern Africa," Dr. Murray said.

"It means, to us, that if you want to tackle maternal mortality in those regions, you need to pay attention to the management of H.I.V. in pregnant women. It's not about emergency obstetrical care, but about access to antiretrovirals."

In the online abstract of the study the researchers note that, while "only 23 countries are on track to achieve a 75% decrease in MMR by 2015" -- Millennium Goal 5 -- "countries such as Egypt, China, Ecuador, and Bolivia have been achieving accelerated progress."

In light of the importance that the "safe motherhood" movement has given to legalising abortion, it is interesting that three of those countries have very restrictive abortion laws. It is not long since we noted here the correlation between restrictive abortion laws and low or sharply declining maternal mortality rates in several countries -- notably Chile.

On the other hand, the new study shows that liberal abortion regimes can be consistent with a rise in maternal mortality. The United States rate has risen from 12 deaths per 100,000 live births in 1980 to 17 in 2008; Canada's has hovered between 6 and 7, and Norway's has risen from 7 to 8.

That leaves China and India, of course, where abortion is not so much a "liberal" option as a weapon of the state in birth control. Forcing the birth rates down would have something to do with their reductions in maternal mortality, along with improvements in maternal care. It may turn out that the legal status of abortion is not particularly relevant to this question -- but that goes for both sides of the debate.