1. ESA/STAT/AC.219/16 Trends in maternal mortality 1990-2008 Holly Newby Statistics and Monitoring Section

2. Released September 2010 Includes trends for 172 countries UN inter-agency estimates for 2008

3. Maternal Mortality Estimation Inter-agency Group (MMEIG) The 2008 UN inter-agency estimates were produced by the Maternal Mortality Estimation Inter-agency Group (MMEIG): WHO UNICEF UNFPA The World Bank Technical Advisory Group

4. Definitions Methodological approach Findings

6. Definition of maternal death The 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. WHO International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, 1992 (ICD-10),

7. Maternal mortality ratio (MMR) The MMR is the… Number of maternal deaths per 100,000 live births MDG Target 5.A: Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

8. Measurement challenges To accurately categorize a death as maternal information is needed regarding: – cause of death – pregnancy status – timing of death in relation to the pregnancy Large confidence intervals

9. Definitions Methodological approach Findings

10. Sources of maternal mortality data Maternal mortality data can come from a variety of sources: – Civil registration systems – Household surveys – Censuses – Reproductive-age mortality studies (RAMOS) – Sisterhood methods – Verbal autopsies

11. Interagency approach to measuring maternal mortality Civil registration – data adjusted and used directly for estimating MMR Lacking civil registration data – multilevel regression model developed using available national level data

12. Interagency approach to measuring maternal mortality Civil registration – data adjusted and used directly for estimating MMR Lacking civil registration data – multilevel regression model developed using available national level data % of countries in each category

13. Interagency approach to measuring maternal mortality Civil registration – data adjusted and used directly for estimating MMR Lacking civil registration data – multilevel regression model developed using available national level data % of countries in each category

14. Overview of the model Multilevel regression model (for 113 countries) Three covariates selected from larger list of potential indicators: – Gross domestic product per capita (GDP) – General fertility rate (GFR) – Skilled attendant at delivery (SAB)

15. Definitions Methodological approach Findings

16. Substantial geographic variation in MMRs

17. Approximately 9 in every 10 maternal deaths in sub-Saharan Africa or South Asia Global distribution of maternal deaths, 2008 358,000 maternal deaths worldwide

18. Maternal mortality is declining

19. 34% decline

20. MMRs decline across all developing regions Maternal deaths per 100,000 live births

21. Conclusion Substantial progress made: – 34% decline in developing world – 188,000 fewer deaths today than in 1990 – 58 countries are making progress or on-track But more needs to be done – MDG target requires 5.5% annual decline, but current rate is 2.3% to date – 358,000 maternal deaths, mostly preventable – Every year 45,000 births are not attended by skilled health personnel

22. www.childinfo.org/maternal_mortality.html