Abstract
Original language | English |
---|---|
Pages (from-to) | 1775-1812 |
Number of pages | 38 |
Journal | The Lancet |
Volume | 388 |
Issue number | 10053 |
DOIs | |
Publication status | Published - 2016 |
Open Access - Access Right Statement
The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license.Keywords
- mortality
- mothers
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In: The Lancet, Vol. 388, No. 10053, 2016, p. 1775-1812.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Global, regional, and national levels of maternal mortality, 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015
AU - Kassebaum, Nicholas J.
AU - Barber, Ryan M.
AU - Bhutta, Zulfiqar A.
AU - Dandona, Lalit
AU - Gething, Peter W.
AU - Hay, Simon I.
AU - Kinfu, Yohannes
AU - Larson, Heidi J.
AU - Liang, Xiaofeng
AU - Lim, Stephen S.
AU - Lopez, Alan D.
AU - Lozano, Rafael
AU - Mensah, George A.
AU - Mokdad, Ali H.
AU - Naghavi, Mohsen
AU - Pinho, Christine
AU - Salomon, Joshua A.
AU - Steiner, Caitlyn
AU - Vos, Theo
AU - Wang, Haidong
AU - Abajobir, Amanuel Alemu
AU - Abate, Kalkidan Hassen
AU - Abbas, Kaja M.
AU - Abd-Allah, Foad
AU - Abdallat, Mahmud A.
AU - Abdulle, Abdishakur M.
AU - Abera, Semaw Ferede
AU - Aboyans, Victor
AU - Abubakar, Ibrahim
AU - Abu-Rmeileh, Niveen M. E.
AU - Achoki, Tom
AU - Adebiyi, Akindele Olupelumi
AU - Adedeji, Isaac Akinkunmi
AU - Adelekan, Ademola Lukman
AU - Adou, Arsène Kouablan
AU - Afanvi, Kossivi Agbelenko
AU - Agarwal, Arnav
AU - Kiadaliri, Aliasghar Ahmad
AU - Ajala, Oluremi N.
AU - Akinyemiju, Tomi F.
AU - Akseer, Nadia
AU - Al-Aly, Ziyad
AU - Alam, Khurshid
AU - Alam, Noore K. M.
AU - Alasfoor, Deena
AU - Aldhahri, Saleh Fahed
AU - Aldridge, Robert William
AU - Alhabib, Samia
AU - Ali, Raghib
AU - Alkerwi, Ala’a
AU - Alla, François
AU - Al-Raddadi, Rajaa
AU - Alsharif, Ubai
AU - Martin, Elena Alvarez
AU - Alvis-Guzman, Nelson
AU - Amare, Azmeraw T.
AU - Amberbir, Alemayehu
AU - Amegah, Adeladza Kofi
AU - Ammar, Walid
AU - Amrock, Stephen Marc
AU - Andersen, Hjalte H.
AU - Anderson, Gregory M.
AU - Antoine, Rose Mayerline
AU - Antonio, Carl Abelardo T.
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AU - Ärnlöv, Johan
AU - Arora, Megha
AU - Arsenijevic, Valentina S Arsic
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PY - 2016
Y1 - 2016
N2 - Background: In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods: We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings: Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation: Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.
AB - Background: In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods: We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings: Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation: Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population.
KW - mortality
KW - mothers
UR - http://handle.westernsydney.edu.au:8081/1959.7/uws:41691
U2 - 10.1016/S0140-6736(16)31470-2
DO - 10.1016/S0140-6736(16)31470-2
M3 - Article
SN - 0140-6736
VL - 388
SP - 1775
EP - 1812
JO - The Lancet
JF - The Lancet
IS - 10053
ER -