Two significant topics are causing buzz in maternal and infant health circles: (1) on Monday, the Lancet published an article that shows significant decline in the number of maternal deaths, from 526,300 deaths in 1980 to 342,900 deaths in 2008, representing a 35% decline; and (2) today, the UN Secretary-General Ban Ki-Moon has announced a joint action plan for accelerating progress on maternal and newborn health. As I began wading through the documents, I became interested in the definitions of terms, and thought they might be useful to others:
Maternal mortality refers to deaths that can be attributed to pregnancy and delivery. The WHO defines “maternal mortality” as “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.”
This is an authoritative definition, but not the only one: other definitions do include accidental or incidental causes, often related to violence or socio-economic circumstances. The definition used by disease classifiers is slightly different as well – the Tenth International Classification of Disease developed a new definition in 1992, which states that any woman who dies during or within 42 days of pregnancy outomce is classified as a pregnancy-related death. The definition continues to be controversial; in fact, the US as declined to use this definition, causing noise in the maternal mortality figures.
The maternal death rate is most commonly measured through the maternal mortality ratio (MMR), which is the ratio of maternal deaths per 100,000 live births. Total number of maternal deaths is also a commonly used figure, as studied in Monday’s Lancet article.
The WHO promotes safe motherhood as an element of the Continuum of Care for maternal, newborn and child health (dubbed MNCH), and advocates for integrated service delivery (which includes linkages between families, communities, outpatient services, clinics and other health facilities) along two dimensions: time and place.
Diagram sources: WHO
Goal 5 of the Millennium Development Goals is specifically targeted to maternal health, specifying a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015. You can track the progress against this goal at MDGMonitor’s maternal health map. While there has been progress against this goal, it has been inconsistent and isolated to certain regions, with some disconcerting surprises.
Maternal mortality is tracked closely not just because it is a fundamental issue of human rights, but also because it is considered an indicator for a country’s health system. Which is why recent statistics from the US are so concerning: last month, Amnesty International called the US increase in maternal deaths (which have doubled in the last 20 years by some counts) a “scandal”. And this post from Philip Cohen at the Huffington Post shows that the US is joined only by a handful of sub-Saharan African states with increases in maternal deaths.
