Today’s new estimates of maternal mortality from the United Nations’ Maternal Mortality Estimation Inter-Agency Group (MMEIG) are good news – but not good enough. All the evidence points to more than a quarter of a million of women still dying as a consequence of pregnancy and childbirth every year – that’s around one every two minutes. We know that adequate logistics and medical care can, in principle, prevent almost all of these deaths. In Scandinavia, rates are down to under 1 in 10,000 births, but for the world as a whole they remain around 20 per 10,000 births, and in some countries maternal deaths still occur in 1% of births – totally unacceptable for the 21st century.
Why do we need to have estimates of these important figures? The answer is that the details, on a world-wide basis, are simply unknown. PLoS Medicine published an interesting series on the pros and cons of global estimates. WHO, on their Twitter feed today, wisely pointed out “not even the best modelling can give us the real figures. Hence, WHO calls for stronger registration of births, deaths, causes of death.” Nevertheless, the inadequate progress on maternal deaths – and the almost inevitable global failure to reach the 75% reduction in maternal mortality called for by Millennium Development Goal 5 (MDG5) by 2015, is all too real, whatever estimation techniques are used.
When new sets of global estimates are published, first attention naturally goes to the headline results – 287,000 maternal deaths during 2010 in today’s report. But such estimates also contain a wealth of detail. One of the trickiest issues in estimating maternal mortality is modelling the interactions between pregnancy and HIV/AIDS in terms of causing women’s deaths, particularly in areas such as southern Africa where HIV/AIDS infections occur at high rates. Women with HIV are less likely to be pregnant in the first place, but being pregnant and HIV positive may represent an increased risk. There’s a whole appendix on the mathematics of this in the new estimates – but the fact remains that there are difficulties and uncertainties in making any such estimates.
There is a risk involved for every woman who gets pregnant. But the global community has the knowledge and resources to manage those risks and minimise adverse consequences. Why can’t we stop mothers dying?
Peter Byass is Professor of Global Health at Umeå University in Sweden and Director of the Umeå Centre for Global Health Research. He is a member of the PLoS Medicine Editorial Board and of the Technical Advisory Group to the UN Maternal Mortality Estimation Inter-Agency Group.