2014年-世界发展银行全球_Trends_in_Maternal_Mortality___1990_to_2013_68页_1mb

Summary of Trends in Maternal Mortality: 1990 to 2013

Core Content

This document presents the trends in maternal mortality from 1990 to 2013, based on estimates by the Maternal Mortality Estimation Inter-Agency Group (MMEIG), which includes the World Health Organization (WHO), UNICEF, UNFPA, The World Bank, and the United Nations Population Division (UNPD). The report highlights the progress made in reducing maternal mortality globally, as well as the challenges in accurately measuring it.

Main Points

• Global Maternal Mortality:
  In 2013, an estimated 289,000 maternal deaths occurred worldwide, representing a 45% decline from 1990.
  The global maternal mortality ratio (MMR) was 210 maternal deaths per 100,000 live births in 2013, down from 380 in 1990.

• Regional Distribution:

  • Sub-Saharan Africa accounted for 62% (179,000) of global maternal deaths.
  • Southern Asia accounted for 24% (69,000).
  • India and Nigeria were the two countries with the highest shares of global maternal deaths (17% and 14%, respectively).
  • Sub-Saharan Africa had the highest regional MMR at 510, while high-income countries had the lowest at 1 in 3400.

• Country-Level Progress:

  • On Track: 11 countries achieved a 75% or greater decline in MMR from 1990 to 2013.
  • Making Progress: 63 countries showed significant but less than 75% reduction.
  • Insufficient Progress: 13 countries did not achieve substantial reduction in MMR.

• AIDS-Related Maternal Deaths:

  • Sub-Saharan Africa accounted for 6800 (91%) of the estimated 7500 maternal deaths attributed to AIDS globally.
  • The proportion of maternal deaths attributed to AIDS in sub-Saharan Africa was 3.8%, resulting in an AIDS-attributed MMR of 19 per 100,000 live births.
  • Thirteen countries had 10% or more of maternal deaths attributed to AIDS.

• Measuring Maternal Mortality:

  • The MMR is defined as maternal deaths per 100,000 live births.
  • The MMRate is defined as maternal deaths per woman aged 15–49 years or per woman-year lived in that age range.
  • The adult lifetime risk of maternal mortality is also calculated, indicating the likelihood that a woman will die from maternal causes during her lifetime.

• Data Sources and Methodology:

  • The MMEIG uses multiple data sources, including civil registration, surveys, and administrative data.
  • The methodology involves statistical modeling and multi-level regression models to estimate maternal mortality.
  • The estimates are updated based on newly available data and country consultations.

• Challenges in Data Collection:

  • Less than 40% of countries have complete civil registration systems with good cause-of-death attribution.
  • In many countries, especially those with limited health infrastructure, maternal deaths are not accurately recorded or classified.
  • The ICD-10 classification is used to identify maternal deaths, but implementation varies across countries.

• Key Definitions:

  • Maternal Death: Death of a woman during pregnancy or within 42 days of termination, due to pregnancy-related causes, excluding accidental or incidental causes.
  • Pregnancy-Related Death: Death of a woman during pregnancy or within 42 days of termination, regardless of cause.
  • Late Maternal Death: Death due to direct or indirect obstetric causes more than 42 days but less than one year after termination of pregnancy.
  • AIDS-Related Indirect Maternal Deaths: Deaths due to the interaction between HIV and pregnancy, categorized under ICD-MM Group 7.
  • AIDS Deaths: Deaths due to HIV complications, not related to pregnancy, classified under ICD-10 codes B20–B24.

• Methodological Updates:

  • The MMEIG has improved methods over time, incorporating more accurate data sources and statistical techniques.
  • The estimates are made publicly available, promoting transparency and open access.
  • The report includes country-specific and regional estimates, as well as trend analyses from 1990 to 2013.

• Strategies for Improvement:

  • Successful strategies for reducing maternal mortality include leadership, partnerships, evidence-based policies, and adaptation to changing conditions.
  • Maternal death reviews and improved data collection are critical tools for improving maternal mortality estimates and guiding interventions.

• Post-2015 Agenda:

  • The progress made towards MDG 5 (Improving maternal health) suggests that preventable maternal mortality could be eliminated in this generation.
  • The report emphasizes the need for continued investment in maternal health and data systems.

Key Information

• Estimated Maternal Deaths in 2013:

  • Global: 289,000
  • Sub-Saharan Africa: 179,000 (62%)
  • Southern Asia: 69,000 (24%)
  • India: 50,000 (17%)
  • Nigeria: 40,000 (14%)
  • Sierra Leone: 1100 (highest MMR)
  • Chad and Somalia: Highest lifetime risk of maternal death (1 in 15 and 1 in 18, respectively)

• Global MMR in 2013:

  • 210 maternal deaths per 100,000 live births
  • Developed regions: 16
  • Developing regions: 230

• AIDS-Related Maternal Deaths:

  • Sub-Saharan Africa: 6800 (91%)
  • AIDS-attributed MMR in sub-Saharan Africa: 19 per 100,000 live births
  • 13 countries had 10% or more of maternal deaths attributed to AIDS

• Countries with High MMR (≥100 in 1990):

  • 11 countries were categorized as 'on track'
  • 63 countries were categorized as 'making progress'
  • 13 countries were categorized as 'insufficient progress'

• Data Sources:

  • Civil registration (Group A)
  • Statistical models (Groups B and C)
  • Surveys and administrative data
  • Country consultations

• Tools for Improvement:

  • Maternal death reviews
  • Enhanced data collection and classification
  • Integration of health information systems

Conclusion

The report underscores the significant progress made in reducing maternal mortality since 1990, with a 45% global decline by 2013. However, it also highlights the persistent challenges in data collection and accurate measurement of maternal deaths, especially in low-income and sub-Saharan African countries. The MMEIG continues to refine methodologies and improve data quality to support better maternal health outcomes and accountability.