Maternal mortality

Maternal mortality declined by 38 per cent between 2000 and 2017

Maternal mortality refers to deaths due to complications from pregnancy or childbirth. From 2000 to 2017, the global maternal mortality ratio declined by 38 per cent – from 342 deaths to 211 deaths per 100,000 live births, according to UN inter-agency estimates. This translates into an average annual rate of reduction of 2.9 per cent. While substantive, this is less than half the 6.4 per cent annual rate needed to achieve the Sustainable Development global goal of 70 maternal deaths per 100,000 live births.

There has been significant progress since 2000. Between 2000 and 2017, South Asia achieved the greatest overall percentage reduction in MMR, with a reduction of 59 per cent (from 395 to 163 maternal deaths per 100,000 live births). Sub-Saharan Africa achieved a substantial reduction of 39 per cent of maternal mortality during this period.

Levels of maternal mortality

The number of women and girls who died each year from complications of pregnancy and childbirth declined from 451,000 in 2000 to 295,000 in 2017. These improvements are particularly remarkable in light of rapid population growth in many of the countries where maternal deaths are highest. Still, over 800 women are dying each day from complications in pregnancy and childbirth. And for every woman who dies, approximately 20 others suffer serious injuries, infections or disabilities.

Two regions, sub-Saharan Africa and South Asia, account for 86 per cent of maternal deaths worldwide. Sub-Saharan Africans suffer from the highest maternal mortality ratio – 533 maternal deaths per 100,000 live births, or 200,000 maternal deaths a year. This is over two thirds (68 per cent) of all maternal deaths per year worldwide. South Asia follows, with a maternal mortality ratio of 163, or 57,000 maternal deaths a year, accounting for 19 per cent of the global total. Furthermore, regional and global averages tend to mask large disparities both within and between countries.

Every region has advanced, although levels of maternal mortality remain unacceptably high in sub-Saharan Africa. Almost all maternal deaths can be prevented, as evidenced by the huge disparities found across regions and between the richest and poorest countries. The lifetime risk of maternal death in high-income countries is 1 in 5,400, compared to 1 in 45 in low-income. The global lifetime risk of maternal death nearly halved between 2000 and 2017, from 1 in 100, to 1 in 190.

Causes of maternal death

Haemorrhage remains the leading cause of maternal mortality, accounting for over one quarter (27 per cent) of deaths. Similar proportion of maternal deaths were caused indirectly by pre-existing medical conditions aggravated by the pregnancy. Hypertensive disorders of pregnancy, especially eclampsia, as well as sepsis, embolism and complications of unsafe abortion also claim a substantial number of lives.

The complications leading to maternal death can occur without warning at any time during pregnancy and childbirth. Most maternal deaths can be prevented if births are attended by skilled health personnel – doctors, nurses or midwives – who are regularly supervised, have the proper equipment and supplies, and can refer women in a timely manner to emergency obstetric care when complications are diagnosed. Complications require prompt access to quality obstetric services equipped with life-saving drugs, including antibiotics, and the ability to provide blood transfusions needed to perform Caesarean sections or other surgical interventions.

The causes of maternal death are mostly preventable

Lifetime risk of maternal death

The lifetime risk of maternal death is the probability that a 15-year-old girl will die from complications of pregnancy or childbirth over her lifetime; it takes into account both the maternal mortality ratio and the total fertility rate (average number of births per woman during her reproductive years under current age-specific fertility rates). Thus, in a high-fertility setting, a woman faces the risk of maternal death multiple times, and her lifetime risk of death will be higher than in a low-fertility setting. Similar to maternal mortality ratio, the lifetime risk of maternal death varies largely across countries. In 2017, the lifetime risk of maternal death in low income countries as a whole was 1 in 45, compared to 1 in 5,400 in high-income countries. Among regions, women in sub-Saharan Africa face the highest lifetime risk (1 in 38), followed by South Asia (1 in 240).

The lifetime risk of maternal death ranges from 1 in 5,400 in high income countries to 1 in 45 in low income countries

References

WHO, UNICEF, UNFPA and The World Bank, Trends in Maternal Mortality: 2000 to 2017 WHO, Geneva, 2019

Leontine Alkema-Doris Chou-Daniel Hogan-Sanqian Zhang-Ann-Beth Moller-Alison Gemmill-Doris Fat-Ties Boerma-Marleen Temmerman-Colin Mathers-Lale Say, Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group, The Lancet Published Online November 12, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)00838-

AbouZahr, C., and T. Wardlaw, ‘Maternal Mortality at the End of the Decade: What signs of progress?’, Bulletin of the World Health Organization, vol. 79, no. 6, 2001, pp. 561─573.

Khan, Khalid S., et al., ‘WHO Analysis of Causes of Maternal Death: A systematic review’, Lancet, vol. 367, no. 9516, 1 April 2006, pp. 1066─1074.

Say L et al., ‘Global causes of maternal death: a WHO systematic analysis’ Lancet Global Health. http://dx.doi.org/10.1016/S2214-109X(14)70227-X, May 6, 2014.

UNICEF, Progress for Children: Achieving the MDGs with equity, Report No. 9, UNICEF, New York, 2011.

UNICEF, Progress for Children: A report card on maternal mortality, Report No. 7, UNICEF, New York, 2008.

UNICEF, WHO and UNFPA, Guidelines for Monitoring the Availability and Use of Obstetric Services, UNICEF, New York, 1997.

WHO and UNICEF, The Sisterhood Method for Estimating Maternal Mortality: Guidance notes for potential users, WHO, Geneva 1997.

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Trends in estimates of maternal mortality ratio (maternal deaths per 100,000 live births) 2000-2017
September 2019 Download document

Resources

Publications

Countdown to 2030: Tracking Progress Towards Universal Coverage for Women’s, Children’s and Adolescents’ Health

Publications

Trends in Maternal Mortality 2000-2017

Journal articles

Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia

Guidance

Indicator and Monitoring Framework for the Global Strategy for Women’s, Children’s and Adolescents’ Health

Publications

The Global Strategy for Women’s, Children’s and Adolescents’ Health

Strategies Toward Ending Preventable Maternal Mortality

Notes on the data

Sustainable Development Goal	Target	Indicator
Goal 3: Ensure healthy lives and promote well-being for all at all ages	Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births	3.1.1 Maternal mortality ratio

Definition: The maternal mortality ratio (MMR) is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period. It depicts the risk of maternal death relative to the number of live births and essentially captures the risk of death in a single pregnancy or a single live birth. Maternal deaths: The annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, expressed per 100,000 live births, for a specified time period.

Rationale: All maternal mortality indicators derived from the 2019 estimation round include a point-estimate and an 80% uncertainty interval (UI). For those indicators where only point-estimates are reported in the text or tables, UIs can be obtained from supplementary material online. Both point-estimates and 80% UIs should be taken into account when assessing estimates. For example: The estimated 2017 global MMR is 211 (UI 199 to 243) This means: The point-estimate is 211 and the 80% uncertainty interval ranges 199 to 243.

The amount of data available for estimating an indicator and the quality of that data determine the width of an indicator’s UI. As data availability and quality improve, the certainty increases that an indicator’s true value lies close to the point-estimate.

For more information on the metadata please visit SDG metadata.

Maternal mortality country profiles

The profiles below detail the new round of estimates developed by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division for the years 2000-2017. For further information visit, Trends in maternal mortality: 2000–2017.