Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
In parts of the world, women have prescribed responsibilities and face discrimination in their societies. As a result, these gender-related risks that women confront raise unique health challenges. Morbidity, disability and premature death of women due to these risk factors can result in many social and economic consequences, impacting women, their families and their societies at large. Since poor maternal health could pose challenges to the health of populations and the development of societies in a long run, women’s health is placed at a prominent place on the global health agenda.
One of the most vulnerable moments women face during their lifetime is giving birth to a child, as this is a phase when both biological and social factors can contribute to negative health outcomes. In 2017, 295,000 women worldwide died during and following pregnancy and childbirth, which equates to approximately 810 women dying every day. 94% of these deaths occurred in low-resource settings, in which women have limited access to basic health services they need. Ensuring a positive and safe experience would not only benefit the women, but also guarantee the well-being of their children. These reasons mark the importance of addressing women’s health during pregnancy, childbirth and after delivery.
Maternal Health refers to the health of women during pregnancy, childbirth and the postnatal period.
One way to gain an initial understanding of maternal health status of a population is by examining key indicators. In the field of maternal health, maternal mortality ratio (MMR) is the most commonly-used indicator. According to the World Health Organization’s definition, maternal mortality ratio refers to “the number of maternal deaths during a given time period per 100,000 live births during the same time period,” and its unit is “deaths per 100,000 live births.” Maternal deaths include deaths caused by diseases related to pregnancy and its management during pregnancy, childbirth and within 42 days of the end of pregnancy.
Global Overview of Maternal Health
According to a UN inter-agency report, the global maternal mortality ratio is 211 deaths per 100,000 live births in 2017, a 38% decline from 342 deaths per 100,000 live births in 2000. This indicates an average annual reduction of 2.9%. This global decrease is marked by significant progress made by many countries towards achieving Target 3.1 of the Sustainable Development Goals, which is reducing the world MMR to less than 70 deaths per 100,000 live births in 2030. A comparison of countries that have reached the SDG target in 1990 and 2015 shows that the number of countries that have not met the goal (shown in red) decreased significantly, especially in Asia and South America.
Yet, challenges persist. To achieve the SDGs Target, MMR needs to reach an annual reduction rate of 6.4%. But as previously mentioned, the annual average reduction rate is only 2.9%, which is far from enough. In addition to the insufficient degree in global decrease, the country-level MMRs also indicate huge disparities between different regions. For example, Egypt is the only African country that reached the SDG target from 1990 to 2015, reducing its MMR from 106 per 100,000 live births in 1990 to 33 per 100,000 live births in 2015. MMR in other African countries remains high. For example, Sierra Leone’s MMR in 2015 is 1,120 per 100,000 live births, way higher than the goal of 70 per 100,000 live births.
According to the WHO, Sub-Saharan Africa (SSA) and Southern Asia (SA) accounted for around 84% of maternal deaths worldwide in 2017. With 542 deaths per 100,000 live births, the average MMR of the Sub-Saharan Africa region is 45 times higher than 12 deaths per 100,000 live births in Europe and Northern America. This huge inequality shows the uneven distribution of medical resources around the world, presenting the urgency of putting in efforts to improve health resources and systems in middle- and low-income countries.
China’s earliest reporting of MMR was in 1996, with 68 deaths per 100,000 live births. Starting in 2000, China has been reporting the indicator annually, and the numbers have been decreasing steadily. In 2017, MMR was 29 deaths per 100,000 live births.
Impacts of Negative Maternal Health Status
Women who have negative pregnancy and childbirth experiences can face both physical and psychological trauma. If women are unable to get the medical care they need during childbirth and especially emergencies, they are likely to experience dangerous medical conditions, such as severe bleeding and high blood pressure. They could also have prolonged labor, with some lasting for more than one week. This could lead to many lifelong complications such as obstetric fistula, a hole developed in the birth canal resulting in incontinence of urine or feces, as well as stillbirths, meaning that the babies are delivered dead. These experiences can also have adverse effects on women’s mental health, because they could experience social isolation and discrimination from their communities.
In addition to causing harm to women themselves, bad maternal health status can also have wider social impact. For children whose mothers have passed away because of childbirth, they might not be well cared for as they grow up. They could have less access to food, clean and safe living conditions and education, while having more economic risks. These factors could all lead to further negative health outcomes for the children and the population, which could contribute to economic instability, loss of workforce and social conflict. Communities facing these risks may enter a cycle of poverty, in which they will always encounter similar problems without having a way out. This cycle will limit the potential for countries to develop in the future, making it more difficult for the populations to improve their quality of life.
Addressing maternal health is one of the most pressing issues in global health, as it can influence both the health status and the development of societies. An examination of the maternal mortality ratio, the key indicator of the field, shows that although progress has been made, the world has to work hard to achieve the related SDGs. National and international efforts need to be focused on addressing maternal health, especially in the Sub-Saharan Africa region, where MMR remains unfortunately high. In the next article, we will examine the risk factors contributing to high MMR, major causes of maternal mortality and discuss potential interventions and solutions.
About the author
Yuxuan Liu is a journalist/columnist in SRP’s Writing and Interviewing Program. She is a sophomore in college studying Global Health who loves mint and chocolate chips ice cream.