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2000 to 2017 Executive summary TRENDS IN MATERNAL MORTALITY 2000 to 2017 Estimates by WHO, UNICEF, UNFPA, World Bank Group and For more information, please contact: Department of Reproductive Health and Research the United Nations Population Division World Health Organization Avenue Appia 20 CH-1211 Geneva 27 Switzerland Email: [email protected] www.who.int/reproductivehealth WHO/RHR/19.23 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Cover.indd 1 22.11.19 13:06 EXECUTIVE SUMMARY Background Bank Group and the United Nations Population Division The Sustainable Development Goals (SDGs) were (UNPD) of the Department of Economic and Social launched on 25 September 2015 and came into force Affairs – has collaborated with external technical experts on 1 January 2016 for the 15-year period until 31 on a new round of estimates for 2000–2017. To provide December 2030. Among the 17 SDGs, the direct health- increasingly accurate MMR estimates, the previous related targets come under SDG 3: Ensure healthy estimation methods have been refined to optimize use lives and promote well-being for all at all ages. With of country-level data. Consultations with countries were the adoption of the SDGs, the United Nations Member carried out during May and June 2019. This process States extended the global commitments they had generated additional data for inclusion in the maternal made in 2000 to the Millennium Development Goals mortality estimation model, demonstrating widespread (MDGs), which covered the period until 2015. expansion of in-country efforts to monitor maternal mortality. In anticipation of the launch of the SDGs, the World Health Organization (WHO) and partners released a This report presents internationally comparable global, consensus statement and full strategy paper on ending regional and country-level estimates and trends for preventable maternal mortality (EPMM). The EPMM maternal mortality between 2000 and 2017.1 Countries target for reducing the global maternal mortality ratio and territories included in the analyses are WHO (MMR) by 2030 was adopted as SDG target 3.1: Member States with populations over 100 000, plus two reduce global MMR to less than 70 per 100 000 live territories (Puerto Rico, and the West Bank and Gaza births by 2030. Strip)2. The results described in this report include the first available estimates for maternal mortality in the Having targets for mortality reduction is important, but SDG reporting period; but since two years (2016 and accurate measurement of maternal mortality remains 2017) is not sufficient to show trends, estimates have challenging and many deaths still go uncounted. Many been developed and presented covering the period countries still lack well functioning civil registration and 2000 to 2017. The new estimates presented in this vital statistics (CRVS) systems, and where such systems report supersede all previously published estimates do exist, reporting errors – whether incompleteness for years that fall within the same time period. Care (unregistered deaths, also known as “missing”) or should be taken to use only these estimates for the misclassification of cause of death – continue to pose a interpretation of trends in maternal mortality from 2000 major challenge to data accuracy. to 2017; due to modifications in methodology and data availability, differences between these and previous estimates should not be interpreted as representing Methods and interpretation time trends. In addition, when interpreting changes in MMRs over time, one should take into consideration The United Nations Maternal Mortality Estimation that it is easier to reduce the MMR when the level is Inter-Agency Group (UN MMEIG) – comprising WHO, high than when the MMR level is already low. The full the United Nations Children’s Fund (UNICEF), the database, country profiles and all model specification United Nations Population Fund (UNFPA), the World codes used are available online.3 1 Estimates have been computed to ensure comparability across countries, thus they are not necessarily the same as official statistics of the countries, which may use alternative rigorous methods. 2 Puerto Rico is an Associate Member, and the West Bank and Gaza Strip is a member in the regional committee for the WHO Eastern Mediterranean Region. 3 Available at: www.who.int/reproductivehealth/publications/maternal-mortality-2017/en/. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division 1 Global estimates for 2017 and trends for 2000– 7800 in Australia and New Zealand. Moderate MMR 2017 (100–299) was estimated in Northern Africa, Oceania (excluding Australia and New Zealand), Southern Asia, The global estimates for the year 2017 indicate that South-Eastern Asia and in small island developing there were 295 000 (UI 279 000 to 340 000)4 maternal States. Four subregions (Australia and New Zealand, deaths; 35% lower than in 2000 when there were an Central Asia, Eastern Asia and Western Asia) and two estimated 451 000 (UI 431 000 to 485 000) maternal regions (Latin America and the Caribbean, and Europe deaths. The global MMR in 2017 is estimated at 211 and Northern America) have low MMR (< 100 maternal (UI 99 to 243) maternal deaths per 100 000 live births, deaths per 100 000 live births). representing a 38% reduction since 2000, when it was estimated at 342. The average annual rate of reduction Sub-Saharan Africa and Southern Asia accounted for (ARR) in global MMR during the 2000–2017 period approximately 86% (254 000) of the estimated global was 2.9%; this means that, on average, the global maternal deaths in 2017, with sub-Saharan Africa MMR declined by 2.9% every year between 2000 and alone accounting for roughly 66% (196 000), while 2017. The global lifetime risk of maternal mortality for a Southern Asia accounted for nearly 20% (58 000). 15-year-old girl in 2017 was estimated at 1 in 190; nearly South-Eastern Asia, in addition, accounted for over half of the level of risk in 2000: 1 in 100. The overall 5% of global maternal deaths (16 000). Three countries proportion of deaths to women of reproductive age are estimated to have had extremely high MMR in 2017 (15–49 years) that are due to maternal causes (PM) was (defined as over 1000 maternal deaths per 100 000 estimated at 9.2% (UI 8.7% to 10.6%) in 2017 – down by live births): South Sudan (1150; UI 789 to 1710), Chad 26.3% since 2000. This means that compared with other (1140; UI 847 to 1590) and Sierra Leone (1120; UI 808 to causes of death to women of reproductive age, the 1620). Sixteen other countries, all also in sub-Saharan fraction attributed to maternal causes is decreasing. Africa except for one (Afghanistan), had very high MMR in 2017 (i.e. estimates ranging between 500 and 999). In addition, the effect of HIV on maternal mortality in Only three countries in sub-Saharan Africa had low 2017 appears to be less pronounced than in earlier MMR: Mauritius (61; UI 46 to 85), Cabo Verde (58; UI years; HIV-related indirect maternal deaths now account 45 to 75) and Seychelles (53; UI 26 to 109). Only one for approximately 1% of all maternal deaths compared country outside the sub-Saharan African region had with 2.5% in 2005, at the peak of the epidemic. high MMR: Haiti (480; UI 346 to 718). Ninety countries were estimated to have MMR of 50 or less in 2017. Regional and country-level estimates for 2017 Nigeria and India had the highest estimated numbers of maternal deaths, accounting for approximately one third MMR in the world’s least developed countries (LDCs) is (35%) of estimated global maternal deaths in 2017, with high,5 estimated at 415 (UI 396 to 477) maternal deaths approximately 67 000 and 35 000 maternal deaths (23% per 100 000 live births, which is more than 40 times and 12% of global maternal deaths), respectively. Three higher than MMR in Europe (10; UI 9 to 11), and almost other countries also had 10 000 maternal deaths or 60 times higher than in Australia and New Zealand (7; UI more: the Democratic Republic of the Congo (16 000), 6 to 8). In the world’s LDCs, where an estimated 130 000 Ethiopia (14 000) and the United Republic of Tanzania maternal deaths occurred in 2017, the estimated (11 000). Sixty-one countries were estimated to have lifetime risk of maternal death was 1 in 56. Sub-Saharan had just 10 or fewer maternal deaths in 2017. Africa is the only region with very high MMR for 2017, estimated at 542 (UI 498 to 649), while the lifetime risk of maternal death was 1 in 37, compared with just 1 in 4 All uncertainty intervals (UIs) reported are 80% UI. The data can be interpreted as meaning that there is an 80% chance that the true value lies within the UI, a 10% chance that the true value lies below the lower limit and a 10% chance that the true value lies above the upper limit. 5 For the purpose of categorization, MMR is considered to be low if it is less than 100, moderate if it is 100–299, high if it is 300–499, very high if it is 500–999 and extremely high if it is equal to or higher than 1000 maternal deaths per 100 000 live births. 2 Trends in maternal mortality 2000 to 2017 EXECUTIVE SUMMARY Table 1. Estimates of maternal mortality ratio (MMR, maternal deaths per 100 000 live births), number of maternal deaths, lifetime risk and proportion of deaths among women of reproductive age that are due to maternal causes (PM), by United
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