The picture of maternal health and maternal mortality has
changed substantially over the last 2 decades with the agreement of Millennium
Development Goals (MDGs) in 1990 and the Sustainable Development Goals (SDGs)
in 2015. Improving global maternal health was one of 8 MDGs and targeted
reducing maternal health issues and subsequent mortality between 1990 and 2015.
WHO defines maternal mortality as “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” Ref 1. The maternal
mortality ratio (MMR) (number of maternal deaths per 100,000 live births) and
the proportion of deaths in women of reproductive age that are due to maternal
causes (PM) are two units of measurement used when examining global maternal
The 2000 Estimate of Maternal Mortality, developed by WHO,
UNFPA and UNICEF highlighted that African countries made up 16 of the 17
highest global MMR rates, with Afghanistan the only non-African entry (Ref 3). To put this into
context, in 2000 Sierra Leone had highest MMR at 2,000 maternal deaths per
100,000 live births compared to the global average of 400, the average in
developing regions of 440 or the average in developed regions of 20 Ref 3.
Between 2000 and 2015 there has been an accelerated decline
in estimated MMR across all MDG regions with developing regions showing an
annual rate of decline of 3.1% with Eastern Asia reporting the highest annual
decline rates and Western Asia the lowest Ref 2.
In 2015, the global MMR had dropped to 216, with developing
regions showing the most marked decrease of 239 from 440 in 2000. Sub-Saharan Africa
MMR fell from 920 in 2000 to 546 in 2015 but remained the region with the
highest MMR globally Ref 2.
Sierra Leone remains the country with the highest MMR, falling from 2,000 in
2000 to 1360 in 2015.
When looking at global MMR trends, it is important to
highlight the regional differences with most deaths occurring in developing
regions with approximately 99% of maternal deaths in 2015 still occurring in
developing regions, with sub-Saharan Africa and Oceania having the highest MMRs
Ref 2. In 2015 the
approximate global lifetime risk for maternal death was 1 in 180 which compared
with the risk in Sierra Leone of 1 in 17 or Chad of 1 in 18 which further
illustrating the regional variabilities.
Section 2: Challenges in reducing maternal mortality (30% of the marks).
The global reduction in maternal mortality since 2000 is sizable
but this reduction has involved facing many complex challenges, challenges that
persist and pose ongoing difficulty in further decreasing mortality rates.
Maternal death is generally due to postnatal complications
or complications during pregnancy and childbirth, most of which are treatable
or preventable (Ref 5).
Therefore, if women had access to, and
availed of, adequate effective antenatal, childbirth and postnatal care, maternal
mortality 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 that
many countries have tried to address using many innovative strategies but they
have all faced complex challenges, some of which are regional or country specific
and others common to all.
Skilled Personnel training
Financing of schemes
lack of information
In a review of innovations and challenges in reducing
maternal mortality in one state in India, challenges surrounding the supply of full
time health care providers to rural areas and deficiency in infrastructure quality