Skip to content

When you choose to publish with PLOS, your research makes an impact. Make your work accessible to all, without restrictions, and accelerate scientific discovery with options like preprints and published peer review that make your work more Open.

PLOS BLOGS Speaking of Medicine and Health

Maternal Mortality Falling – But Still Too High

Today’s new estimates of maternal mortality from the United Nations’ Maternal Mortality Estimation Inter-Agency Group (MMEIG) are good news – but not good enough. All the evidence points to more than a quarter of a million of women still dying as a consequence of pregnancy and childbirth every year – that’s around one every two minutes. We know that adequate logistics and medical care can, in principle, prevent almost all of these deaths. In Scandinavia, rates are down to under 1 in 10,000 births, but for the world as a whole they remain around 20 per 10,000 births, and in some countries maternal deaths still occur in 1% of births – totally unacceptable for the 21st century.

Why do we need to have estimates of these important figures? The answer is that the details, on a world-wide basis, are simply unknown. PLoS Medicine published an interesting series on the pros and cons of global estimates. WHO, on their Twitter feed today, wisely pointed out “not even the best modelling can give us the real figures. Hence, WHO calls for stronger registration of births, deaths, causes of death.” Nevertheless, the inadequate progress on maternal deaths – and the almost inevitable global failure to reach the 75% reduction in maternal mortality called for by Millennium Development Goal 5 (MDG5) by 2015, is all too real, whatever estimation techniques are used.

When new sets of global estimates are published, first attention naturally goes to the headline results – 287,000 maternal deaths during 2010 in today’s report. But such estimates also contain a wealth of detail. One of the trickiest issues in estimating maternal mortality is modelling the interactions between pregnancy and HIV/AIDS in terms of causing women’s deaths, particularly in areas such as southern Africa where HIV/AIDS infections occur at high rates. Women with HIV are less likely to be pregnant in the first place, but being pregnant and HIV positive may represent an increased risk. There’s a whole appendix on the mathematics of this in the new estimates – but the fact remains that there are difficulties and uncertainties in making any such estimates.

There is a risk involved for every woman who gets pregnant. But the global community has the knowledge and resources to manage those risks and minimise adverse consequences. Why can’t we stop mothers dying?

Peter Byass is Professor of Global Health at Umeå University in Sweden and Director of the Umeå Centre for Global Health Research. He is a member of the PLoS Medicine Editorial Board and of the Technical Advisory Group to the UN Maternal Mortality Estimation Inter-Agency Group.

e-mail: peter.byass@epiph.umu.se Twitter: @UCGHR

Discussion
  1. Thanks Professor for this sumary. I’ve particularly liked the clarity & the references. I also think that progress are not anought because of large inequalities which continues to exist, but also countries where MMR encreased between 1990 to 2010. Is this a consequence of politic changes or what (US, croatia, zimbabwe, etc.)? Also, the evidence of global faillure to rich MDG5 becames too real but because of th inacceptability of the maternal mortality phenomena, it will be necessairy to project an other goal, I think.

  2. En rapport avec la question de savoir pourquoi nous ne pouvons pas empecher la mortalité maternelle, alors que des soins de bonne qualité pourraient le faire, je dirai ceci:
    – étant donné le fait que c’est une personne humaine qui octroie les soins en question, ses “petites” subjectivités inévitables dans un monde en plein mouvement socio économique en particulier culturel nous oblige d’une certaine façon à apprendre à chaque d’être d’abord son propre médecin, sa propre infirmière et sa propre accoucheuse. Je me réfère pour cela et entre autre à la surmortalité des femmes d’origine étrangère (études française, voir BEH) ainsi qu’au problème du niveau d’instruction et l’influence très connue des facteurs socio démographiques;
    – il est aussi nécessaire d’améliorer l’accessibilité des soins nécessaires par la formation plus documentée du personnel soignant disponible mais aussi leur accessibilité géographique, économique et culturelle. Culturelle? le cas de le dire, parce que l’utilisatrice ne saura pas en bénéficier si foncièrement dans sa culture il prend ces soins comme étant plutôt le dernier recours (donc un recours tardif!!) après avoir épuisé les autres possibilités (traditionnelles ou parallèles !!).
    – L’ “humanisation des soins et de l’hôpital” est aussi un point qu’il faut épingler: près que partout dans le monde, le fait de se sentir obligé d’aller consulter est ressent comme un stress important; à la crainte des soins dont celles qui sont invasives à y bénéficier (mieux y subir) se superpose la crainte qu’inspire le respect de ces personnes en blanc dont le savoir et l’ascendance scientifique passe au départ pour indiscutable et qui en général entraîne un surcoût de la vie même dans les systèmes où la mutuelle demande un certain ticket modérateur.
    – enfin, étant donné l’expérience de progrès disponible dans certains milieux, tous les espoir restent permis, surtout dans les pays qui “fournissent les chiffres” élevés, ne fût ce que pour approcher les voisins (voisins du nord !)

Leave a Reply

Your email address will not be published. Required fields are marked *


Add your ORCID here. (e.g. 0000-0002-7299-680X)

Back to top