The picture of maternal health and maternal mortality haschanged substantially over the last 2 decades with the agreement of MillenniumDevelopment Goals (MDGs) in 1990 and the Sustainable Development Goals (SDGs)in 2015. Improving global maternal health was one of 8 MDGs and targetedreducing maternal health issues and subsequent mortality between 1990 and 2015.WHO defines maternal mortality as “death of a woman while pregnant or within 42days of termination of pregnancy, irrespective of the duration and site of thepregnancy, from any cause related to or aggravated by the pregnancy or itsmanagement but not from accidental or incidental causes” Ref 1. The maternalmortality ratio (MMR) (number of maternal deaths per 100,000 live births) andthe proportion of deaths in women of reproductive age that are due to maternalcauses (PM) are two units of measurement used when examining global maternalmortality trends.
The 2000 Estimate of Maternal Mortality, developed by WHO,UNFPA and UNICEF highlighted that African countries made up 16 of the 17highest global MMR rates, with Afghanistan the only non-African entry (Ref 3). To put this intocontext, in 2000 Sierra Leone had highest MMR at 2,000 maternal deaths per100,000 live births compared to the global average of 400, the average indeveloping regions of 440 or the average in developed regions of 20 Ref 3. Between 2000 and 2015 there has been an accelerated declinein estimated MMR across all MDG regions with developing regions showing anannual rate of decline of 3.
1% with Eastern Asia reporting the highest annualdecline rates and Western Asia the lowest Ref 2. In 2015, the global MMR had dropped to 216, with developingregions showing the most marked decrease of 239 from 440 in 2000. Sub-Saharan AfricaMMR fell from 920 in 2000 to 546 in 2015 but remained the region with thehighest MMR globally Ref 2.Sierra Leone remains the country with the highest MMR, falling from 2,000 in2000 to 1360 in 2015.
When looking at global MMR trends, it is important tohighlight the regional differences with most deaths occurring in developingregions with approximately 99% of maternal deaths in 2015 still occurring indeveloping regions, with sub-Saharan Africa and Oceania having the highest MMRsRef 2. In 2015 theapproximate global lifetime risk for maternal death was 1 in 180 which comparedwith the risk in Sierra Leone of 1 in 17 or Chad of 1 in 18 which furtherillustrating the regional variabilities. Section 2: Challenges in reducing maternal mortality (30% of the marks).The global reduction in maternal mortality since 2000 is sizablebut this reduction has involved facing many complex challenges, challenges thatpersist and pose ongoing difficulty in further decreasing mortality rates.
Maternal death is generally due to postnatal complicationsor complications during pregnancy and childbirth, most of which are treatableor preventable (Ref 5). Therefore, if women had access to, andavailed of, adequate effective antenatal, childbirth and postnatal care, maternalmortality rates should drop. As highlighted in a UNICEF report into innovative approaches,it is the reach and quality of such care that is a key It is this principal thatmany countries have tried to address using many innovative strategies but theyhave all faced complex challenges, some of which are regional or country specificand others common to all. · Skilled Personnel training· Supplies Availability· Rural isolation· Financing of schemes· poverty· distance· lack of information· inadequate servicesIn a review of innovations and challenges in reducingmaternal mortality in one state in India, challenges surrounding the supply of fulltime health care providers to rural areas and deficiency in infrastructure quality(Ref 4)