Maternal Mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA

Report
from World Health Organization
Published on 20 Oct 2003
Executive Summary
Reduction of maternal mortality is one of the major goals of several recent international conferences and has been included within the Millennium Development Goals (MDGs). However, because measuring maternal mortality is difficult and complex, reliable estimates of the dimensions of the problem are not generally available and assessing progress towards the goal is difficult. In recent years, new ways of measuring maternal mortality have been developed, with the needs and constraints of developing countries in particular in mind. As a result, there is considerably more information available today than was the case even a few years ago. Nonetheless, problems of underreporting and misclassification are endemic to all methods and estimates that are based on household surveys are subject to wide margins of uncertainty because of sample size issues. For all these reasons, it is difficult to compare the data obtained from different sources and to assess the overall magnitude of the problem.

In response to these challenges and in order to improve the information base, WHO, UNICEF and UNFPA have developed an approach to estimating maternal mortality that seeks both to generate estimates for countries with no data and to correct available data for underreporting and misclassification. A dual strategy is used which involves adjusting available country data and developing a simple model to generate estimates for countries without reliable information. The approach, with some variations, was used to develop estimates for maternal mortality in 1990 and 1995 and has been used again for generating these estimates for the year 2000.

On the basis of the present exercise, the estimated number of maternal deaths in 2000 for the world was 529,000 (Table 1). These deaths were almost equally divided between Africa (251,000) and Asia (253,000), with about 4 per cent (22,000) occurring in Latin America and the Caribbean, and less than one per cent (2,500) in the more developed regions of the world. In terms of the Maternal Mortality Ratio (MMR), the world figure is estimated to be 400 per 100,000 live births. By region, the MMR was highest in Africa (830), followed by Asia (330), Oceania (240), Latin America and the Caribbean (190), and the developed countries (20).

The country with the highest estimated number of maternal deaths is India (136,000), followed by Nigeria (37,000), Pakistan (26,000), Democratic Republic of Congo and Ethiopia (24,000 each), the United Republic of Tanzania (21,000), Afghanistan (20,000), Bangladesh (16,000), Angola, China, Kenya (11,000 each), Indonesia and Uganda (10,000 each). These 13 countries account for 67 per cent of all maternal deaths.

However, the number of maternal deaths is the product of the total number of births and obstetric risk per birth, described by the MMR. On a risk per birth basis, the list looks rather different. With the sole exception of Afghanistan, the countries with the highest MMRs are in Africa. The highest MMRs of 1,000 or greater, are, in rank order, Sierra Leone (2,000), Afghanistan (1,900), Malawi (1,800), Angola (1,700), Niger (1,600), the United Republic of Tanzania (1,500), Rwanda (1,400), Mali (1,200), Somalia, Zimbabwe, Chad, Central African Republic, Guinea Bissau (1,100 each), Kenya, Mozambique, Burkina Faso, Burundi, and Mauritania (1,000 each).

Table 1. 2000 Maternal mortality estimates by United Nations MDG regions

REGION
MATERNAL MORTALITY RATIO (MATERNAL DEATHS PER 100,000 LIVE BIRTHS)
NUMBER OF MATERNAL DEATHS
LIFETIME RISK OF MATERNAL DEATH,1 IN:
WORLD TOTAL
400
529,000
74
DEVELOPED REGIONSa
20
2,500
2,800
Europe
24
1,700
2,400
DEVELOPING REGIONS
440
527,000
61
Africa
830
251,000
20
Northern Africab
130
4,600
210
Sub-Saharan Africa
920
247,000
16
Asia
330
253,000
94
Eastern Asia
55
11,000
840
South-Central Asia
520
207,000
46
South-Eastern Asia
210
25,000
140
Western Asia
190
9,800
120
Latin America & the Caribbean
190
22,000
160
Oceania
240
530
83

The Maternal Mortality Ratio is a measure of the risk of death once a woman has become pregnant (see section 2 below). A more dramatic assessment of risk that takes into account both the probability of becoming pregnant and the probability of dying as a result of that pregnancy cumulated across a woman's reproductive years is the lifetime risk of maternal death. Table 1 shows that the lifetime risk of death is highest in sub-Saharan Africa, with as many as one woman in 16 facing the risk of maternal death in the course of her lifetime, compared with one in 2,800 in developed regions.

The purpose of these estimates is to draw attention to the existence and likely dimensions of the problem of maternal mortality. They are indicative of orders of magnitude and are not intended to serve as precise estimates. In addition, these estimates can serve to stimulate greater awareness of and attention to the challenge of measuring maternal mortality. Following the publication of the 1990 and 1995 estimates, a number of countries have been undertaking special studies to assess the completeness and adequacy of their vital registration and health information systems. For other countries, particularly where the only source of data is from sisterhood surveys, the estimates can serve to draw attention to the potential pitfalls associated with such indirect measurement techniques.

The margins of uncertainty associated with the estimated MMRs are very large and the estimates should not, therefore, be used to monitor trends in the short term. In addition, cross-country comparisons should be treated with considerable circumspection because different strategies are used to derive the estimates for different countries rendering comparisons fraught with difficulty.

Notes:

a Includes Europe, Canada, United States of America, Japan, Australia and New Zealand which are excluded from the regional totals.

b Excludes Sudan which is included in sub-Saharan Africa.

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