2015年-世界发展银行全球_Trends_in_Maternal_Mortality___1990_to_2015_100页_3mb

Summary of Trends in Maternal Mortality: 1990 to 2015

Core Content

This document provides a comprehensive analysis of global trends in maternal mortality from 1990 to 2015, based on estimates by the Maternal Mortality Estimation Inter-Agency Group (MMEIG), which includes the World Health Organization (WHO), UNICEF, UNFPA, World Bank Group, and the United Nations Population Division (UNPD). The report highlights progress made towards the Millennium Development Goal (MDG) 5A, which aimed for a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015, and discusses the implications for achieving the Sustainable Development Goal (SDG) 3.1, which targets a global MMR of less than 70 per 100,000 live births by 2030.

Main Points and Key Information

Global Trends in Maternal Mortality

• Global MMR reduction: The global maternal mortality ratio (MMR) fell by nearly 44% from 385 (UI 359 to 427) in 1990 to 216 (UI 207 to 249) in 2015.
• Maternal deaths: The annual number of maternal deaths decreased by 43%, from approximately 532,000 (UI 496,000 to 590,000) in 1990 to an estimated 303,000 (UI 291,000 to 349,000) in 2015.
• Lifetime risk: The global lifetime risk of maternal death dropped from 1 in 73 to 1 in 180.
• Regional distribution: Developing regions account for 99% of global maternal deaths in 2015, with sub-Saharan Africa alone contributing about 66% (201,000 deaths), followed by Southern Asia (66,000 deaths).
• Top MMR regions: Sub-Saharan Africa had the highest MMR in 2015 at 546 (UI 511 to 652), followed by Oceania at 187 (UI 95 to 381).
• Country-level data:
  • Nigeria and India accounted for over one third of all maternal deaths globally in 2015.
  • Sierra Leone had the highest MMR at 1360 (UI 999 to 1980).
  • Countries with very high MMR in 2015 include Central African Republic, Chad, Nigeria, South Sudan, Somalia, Liberia, Burundi, Gambia, Democratic Republic of the Congo, Guinea, Côte d'Ivoire, Malawi, Mauritania, Cameroon, Mali, Niger, Guinea-Bissau, and Kenya.
  • The two countries with the highest lifetime risk of maternal mortality are Sierra Leone (1 in 17) and Chad (1 in 18).
  • High-income countries have a lifetime risk of 1 in 3300, while low-income countries have a risk of 1 in 41.

AIDS-Related Indirect Maternal Deaths

• Global proportion: Approximately 1.6% (4700) of all maternal deaths are estimated to be AIDS-related indirect maternal deaths.
• Sub-Saharan Africa: 2.0% of all maternal deaths are estimated to be AIDS-related indirect maternal deaths, contributing to an AIDS-related indirect MMR of 11 deaths per 100,000 live births.
• High proportion countries: South Africa (32%), Swaziland (19%), Botswana (18%), Lesotho (13%), and Mozambique (11%) had 10% or more of maternal deaths attributed to AIDS-related indirect causes.

MDG 5A Achievement

• Countries that achieved MDG 5A: Nine countries, including Bhutan, Cambodia, and Rwanda, are now categorized as having achieved MDG 5A, with a reduction of at least 75% in MMR between 1990 and 2015.
• Countries making progress: An additional 39 countries are categorized as making progress.
• Countries with insufficient progress: 21 countries made insufficient progress.
• Countries with no progress: 26 countries made no progress.

SDG 3.1 Targets

• Required reduction: To achieve SDG 3.1, the global MMR needs to be reduced by an average of 7.5% annually from 2016 to 2030, which is more than three times the rate of reduction observed between 1990 and 2015.

Methodology and Data

• Methodology: The MMEIG used a Bayesian approach (BMat model) to generate MMR estimates, incorporating country-level data and adjusting for data quality.
• Data sources: Country consultations, civil registration systems, population-based surveys, censuses, and specialized studies were used to improve the accuracy of estimates.
• Uncertainty assessment: The uncertainty intervals reflect the quality of data used, with higher quality data leading to more certain estimates.
• Validation: The model was validated using independent technical advisory groups and country feedback.

Challenges and Recommendations

• Data collection challenges: Many countries still lack comprehensive civil registration systems, leading to underreporting and data inaccuracy.
• Call to action: Improving data quality, expanding civil registration and vital statistics (CRVS), and ensuring accurate cause of death certification are critical to reducing maternal mortality.
• Humanitarian and conflict settings: These settings significantly hinder maternal mortality reduction due to the breakdown of health systems and increased risk of preventable deaths.

Conclusion

The report emphasizes the importance of accurate and internationally comparable maternal mortality data for monitoring progress and planning interventions. It underscores the need for continued efforts to improve data collection, enhance measurement systems, and address inequities in maternal health outcomes. The new Global Strategy for Women's, Children's and Adolescents' Health aims to lead a global collaborative response to end all preventable maternal deaths.