Maternal deaths on the decline?

New research published in  the Lancet (April 2010) shows a sharp decrease in maternal deaths for the first time in decades: from 525,300 maternal deaths in 1980, to 342,900 in 2008.

As the New York Times reported last week, the news came as a surprise to many maternal health advocates—who assumed data would be similar to a 2008 study that estimated little change (and in some reports, an increase) in maternal deaths.

The study, authored by researchers at the University of Washington and the University of Queensland, used larger data sets and additional statistical measurements to reach its conclusions. Study authors assessed maternal mortality rates (MMRs) in 181 countries between 1980 and 2008, using a combination of four data sources: vital records, censuses, published autopsies, and surveys.

What’s responsible for the decline? The authors credit several sources:

  • Lower pregnancy rates in some countries
  • Higher incomes in some countries (which improves access to nutrition and health care), especially parts of Central Asia
  • Higher levels of education for some women, particularly in Sub-Saharan Africa
  • Increasing availability of “skilled attendants” to help women give birth (although the Lancet piece doesn’t expound on this, it seems likely that trained midwives—who understand how to prevent and treat hemorrhage—have played a substantial role in this improvement)

Declining MMRs in two countries–India and China–are responsible for a large portion of the decline. In 1980, there were between 408 and 1,080 maternal deaths/100,000 live births in India. By 2008, that number had dropped to between 154 and 395/100,000 live births. In China, the MMR dropped from 144 to 187/100,000 live births in 1980, to between 35-46 in 2008.

Progress varied tremendously among poorer countries with high MMRs—in the Maldives, it dropped 8.8%/year, but in Zimbabwe, it actually increased 5.5%. And as of 2008, six countries account for more than half of all maternal deaths: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of Congo.

Interestingly, the New York Times article failed to address the increase in maternal deaths in the U.S., Canada, and Denmark.

Study authors note that at least part of the increase in MMR here in the U.S. may be due to the introduction of a separate pregnancy status question on the U.S. death certificate. This addition was meant to address coding concerns that have plagued the measurement of maternal deaths here in the U.S. for decades (for a comprehensive examination of reproductive health surveillance in the U.S., see “Assessing Tragedy: Maternal Morality Surveillance” in volume 9, issue 1 of Healthy Generations).

The New York Times does, however, mention unnamed “advocates” who “tried to pressure [The Lancet] into delaying publication [. . . ] fearing that good news would detract from the urgency of their cause.” Hmm…

For more on the U.S. stats, see a March report from Amnesty International,  Deadly Delivery: The Maternal Health Care Crisis in the USA.