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. 2024 Mar 19:13:e004.
doi: 10.25259/IJMA_679. eCollection 2024.

Thirty Years of United Nations Inter-Agency Working Group's Global, Regional, and National Maternal Mortality Estimates Revisited

Yifru Berhan  1 , Sinteyehu Abeba  2
Affiliations

Thirty Years of United Nations Inter-Agency Working Group's Global, Regional, and National Maternal Mortality Estimates Revisited

Yifru Berhan et al. Int J MCH AIDS. .

Abstract

Over the last three decades, the United Nations interagency working group series of model-based maternal mortality estimation showed a significant reduction in maternal mortality ratio (MMR) at global, regional, and national levels. However, the contribution of sub-Saharan Africa for the global maternal deaths in 2020 was nearly two-fold higher than before, and the top five countries with high burden of maternal deaths remained unchanged after four decades. In this commentary, we argue that not all countries with high maternal deaths had high MMR; the lower MMR was noted as shadowing the large number of maternal deaths in countries with high rates of total births. We critically appraised the changes and challenges in maternal mortality measurements. We recommend the use of multiple indicators and categorizing the absolute number of maternal deaths to assess individual countries' maternal health status. As the majority of maternal deaths are preventable and all maternal deaths are catastrophic to the family, estimating the absolute number of maternal deaths should be given equal weight in future research undertakings.

Keywords: Health Status; Maternal Health; Maternal Mortality; Maternal Mortality Rate; Sub-Saharan Africa; United Nations.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1:
Figure 1:
(panel 1) Sub-Saharan African contribution to the global maternal deaths, (panel 2) total maternal deaths, (panel 3) and the trend of maternal mortality ratio/1,00,000 live births, 1990–2020.
Figure 2:
Figure 2:
The trend of maternal mortality ratio in India and Ethiopia (1990–2020) and projections to 2025 and 2030.
Figure 3:
Figure 3:
The trend of maternal deaths in historically major contributor countries for the global maternal deaths (1990–2020), DR: Democratic Republic (DR) of the Congo.
Supplementary Figure 1:
Supplementary Figure 1:
Top 46 countries (left side) with maternal mortality ratios of above 200/100,000 live births and top 45 countries (right side) with 1,000 and above number of maternal deaths in 2020.
Supplementary Figure 2:
Supplementary Figure 2:
Countries whereby the maternal mortality ratio figure is larger than the number of maternal deaths.
Supplementary Figure 3:
Supplementary Figure 3:
The effect of total births on maternal mortality ratio (MMR) estimates (ignoring the stillbirths, which was 1.9 million or 0.001% of annual global deliveries). A small increment in maternal deaths in countries with relatively lower number of births “exaggerates” the MMRs. Note that countries with very low (<20/annum) maternal deaths were excluded from this analysis for clear visibility of the graph as they pull the total births to maternal deaths ratio up to 90,000 and makes the lower values congested. The total births to maternal deaths ratio are computed against the maternal mortality ratio (red line- curved and blue dots). Source: UN inter-agency group report. A neglected tragedy: the global burden of stillbirths. 2020.
Supplementary Figure 4:
Supplementary Figure 4:
Countries those contributed to two-third (more than 67%) of maternal deaths globally in 2000 (left side) and 2020 (right side). Bangladesh, China, and Angola were no more on the leading list, but were not too far from the lead pack [Figure 3].
See this image and copyright information in PMC

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