Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

N.J. Kassebaum, R.M. Barber, L. Dandona, S.I. Hay, H.J. Larson, S.S. Lim, A.D. Lopez, A.H. Mokdad, M. Naghavi, C. Pinho, C. Steiner, T. Vos, H. Wang, T. Achoki, G.M. Anderson, M. Arora, S. Biryukov, J.D. Blore, A. Carter, D.C. CaseyM.M. Coates, M. Coggeshall, D.J. Dicker, E. Dossou, T. Fleming, M.S. Fraser, J. Friedman, N. Fullman, N. Graetz, J. Hancock, C. Huynh, M. Iannarone, L. Kemmer, X.R. Kulikoff, M.J. Kutz, P.Y. Liu, N. Marquez, A. Misganaw, M.D. Mooney, M. Moradi-Lakeh, M. Ng, G. Nguyen, H. Chang, J. Chang, J.J. Choi, Y.J. Kim, E. Park, H. Park, M. Shin, S. Yoon

Research output: Contribution to journalArticle

211 Citations (Scopus)

Abstract

© 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.
Original languageEnglish
JournalThe Lancet
Volume388
Issue number10053
DOIs
Publication statusPublished - 2016

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Maternal Mortality
Maternal Death
Demography
Reproductive Health
Prenatal Care
Fertility
Cause of Death
Health
Reproductive Health Services
Mothers
Delivery of Health Care
Global Burden of Disease
Ectopic Pregnancy
Information Storage and Retrieval
Conservation of Natural Resources
Family Planning Services
Spontaneous Abortion
Licensure
Contraception
Information Systems

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Kassebaum, N.J. ; Barber, R.M. ; Dandona, L. ; Hay, S.I. ; Larson, H.J. ; Lim, S.S. ; Lopez, A.D. ; Mokdad, A.H. ; Naghavi, M. ; Pinho, C. ; Steiner, C. ; Vos, T. ; Wang, H. ; Achoki, T. ; Anderson, G.M. ; Arora, M. ; Biryukov, S. ; Blore, J.D. ; Carter, A. ; Casey, D.C. ; Coates, M.M. ; Coggeshall, M. ; Dicker, D.J. ; Dossou, E. ; Fleming, T. ; Fraser, M.S. ; Friedman, J. ; Fullman, N. ; Graetz, N. ; Hancock, J. ; Huynh, C. ; Iannarone, M. ; Kemmer, L. ; Kulikoff, X.R. ; Kutz, M.J. ; Liu, P.Y. ; Marquez, N. ; Misganaw, A. ; Mooney, M.D. ; Moradi-Lakeh, M. ; Ng, M. ; Nguyen, G. ; Chang, H. ; Chang, J. ; Choi, J.J. ; Kim, Y.J. ; Park, E. ; Park, H. ; Shin, M. ; Yoon, S. / Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. In: The Lancet. 2016 ; Vol. 388, No. 10053.
@article{fa0e59ea486d4c039a5b593ed5ec484f,
title = "Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015",
abstract = "{\circledC} 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68{\%} in 1990 to more than 80{\%} in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91{\%} coverage of one antenatal care visit, 78{\%} of four antenatal care visits, 81{\%} of in-facility delivery, and 87{\%} of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.",
author = "N.J. Kassebaum and R.M. Barber and L. Dandona and S.I. Hay and H.J. Larson and S.S. Lim and A.D. Lopez and A.H. Mokdad and M. Naghavi and C. Pinho and C. Steiner and T. Vos and H. Wang and T. Achoki and G.M. Anderson and M. Arora and S. Biryukov and J.D. Blore and A. Carter and D.C. Casey and M.M. Coates and M. Coggeshall and D.J. Dicker and E. Dossou and T. Fleming and M.S. Fraser and J. Friedman and N. Fullman and N. Graetz and J. Hancock and C. Huynh and M. Iannarone and L. Kemmer and X.R. Kulikoff and M.J. Kutz and P.Y. Liu and N. Marquez and A. Misganaw and M.D. Mooney and M. Moradi-Lakeh and M. Ng and G. Nguyen and H. Chang and J. Chang and J.J. Choi and Y.J. Kim and E. Park and H. Park and M. Shin and S. Yoon",
year = "2016",
doi = "10.1016/S0140-6736(16)31470-2",
language = "English",
volume = "388",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "10053",

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Kassebaum, NJ, Barber, RM, Dandona, L, Hay, SI, Larson, HJ, Lim, SS, Lopez, AD, Mokdad, AH, Naghavi, M, Pinho, C, Steiner, C, Vos, T, Wang, H, Achoki, T, Anderson, GM, Arora, M, Biryukov, S, Blore, JD, Carter, A, Casey, DC, Coates, MM, Coggeshall, M, Dicker, DJ, Dossou, E, Fleming, T, Fraser, MS, Friedman, J, Fullman, N, Graetz, N, Hancock, J, Huynh, C, Iannarone, M, Kemmer, L, Kulikoff, XR, Kutz, MJ, Liu, PY, Marquez, N, Misganaw, A, Mooney, MD, Moradi-Lakeh, M, Ng, M, Nguyen, G, Chang, H, Chang, J, Choi, JJ, Kim, YJ, Park, E, Park, H, Shin, M & Yoon, S 2016, 'Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015', The Lancet, vol. 388, no. 10053. https://doi.org/10.1016/S0140-6736(16)31470-2

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. / Kassebaum, N.J.; Barber, R.M.; Dandona, L.; Hay, S.I.; Larson, H.J.; Lim, S.S.; Lopez, A.D.; Mokdad, A.H.; Naghavi, M.; Pinho, C.; Steiner, C.; Vos, T.; Wang, H.; Achoki, T.; Anderson, G.M.; Arora, M.; Biryukov, S.; Blore, J.D.; Carter, A.; Casey, D.C.; Coates, M.M.; Coggeshall, M.; Dicker, D.J.; Dossou, E.; Fleming, T.; Fraser, M.S.; Friedman, J.; Fullman, N.; Graetz, N.; Hancock, J.; Huynh, C.; Iannarone, M.; Kemmer, L.; Kulikoff, X.R.; Kutz, M.J.; Liu, P.Y.; Marquez, N.; Misganaw, A.; Mooney, M.D.; Moradi-Lakeh, M.; Ng, M.; Nguyen, G.; Chang, H.; Chang, J.; Choi, J.J.; Kim, Y.J.; Park, E.; Park, H.; Shin, M.; Yoon, S.

In: The Lancet, Vol. 388, No. 10053, 2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

AU - Kassebaum, N.J.

AU - Barber, R.M.

AU - Dandona, L.

AU - Hay, S.I.

AU - Larson, H.J.

AU - Lim, S.S.

AU - Lopez, A.D.

AU - Mokdad, A.H.

AU - Naghavi, M.

AU - Pinho, C.

AU - Steiner, C.

AU - Vos, T.

AU - Wang, H.

AU - Achoki, T.

AU - Anderson, G.M.

AU - Arora, M.

AU - Biryukov, S.

AU - Blore, J.D.

AU - Carter, A.

AU - Casey, D.C.

AU - Coates, M.M.

AU - Coggeshall, M.

AU - Dicker, D.J.

AU - Dossou, E.

AU - Fleming, T.

AU - Fraser, M.S.

AU - Friedman, J.

AU - Fullman, N.

AU - Graetz, N.

AU - Hancock, J.

AU - Huynh, C.

AU - Iannarone, M.

AU - Kemmer, L.

AU - Kulikoff, X.R.

AU - Kutz, M.J.

AU - Liu, P.Y.

AU - Marquez, N.

AU - Misganaw, A.

AU - Mooney, M.D.

AU - Moradi-Lakeh, M.

AU - Ng, M.

AU - Nguyen, G.

AU - Chang, H.

AU - Chang, J.

AU - Choi, J.J.

AU - Kim, Y.J.

AU - Park, E.

AU - Park, H.

AU - Shin, M.

AU - Yoon, S.

PY - 2016

Y1 - 2016

N2 - © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.

AB - © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.

U2 - 10.1016/S0140-6736(16)31470-2

DO - 10.1016/S0140-6736(16)31470-2

M3 - Article

VL - 388

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10053

ER -