Maternal Mortality Declining--Mostly

A couple of days ago I commented on the new Lancet article about child mortality from researchers at the Institute of Health Metrics at the University of Washington. The other article in that issue dealt with maternal mortality--deaths associated with childbearing. [As a sidebar, I should note that these two articles may show up in the Guinness Book of World Records for the largest number of co-authors!] Anyway, the news about maternal mortality is that it is generally on the decline in the world, although there is still substantial global variability, as shown in this map:

On the basis of recent data and a refined understanding of the association between HIV and maternal mortality, we have shown that worldwide maternal mortality has decreased by 1·3% per year since 1990. Despite reductions in the number of maternal deaths—from about 376000 in 1990 to about 293000 in 2013—only 16 countries, seven of which are developing countries, are expected to achieve the MDG 5 target of a 75% reduction in the MMR by 2015. We noted two different patterns in developing countries: sustained substantial decreases in most of Asia and Latin America, and stagnation or increases from 1990 to 2003 in sub-Saharan Africa and Oceania. Increases in some high-income countries such as the USA are a deviation from the general trend downwards in developed countries. However, the substantial acceleration in the decreases since 2003—especially in sub-Saharan Africa—provides hope that more countries can achieve rapid and sustained reductions.

As you might expect, the finding that the maternal mortality ratio (MMR) had increased in the US caught the media's attention. The Washington Post, for example, noted that:

The researchers estimated that 18.5 mothers died for every 100,000 births in the U.S. in 2013, a total of almost 800 deaths. That is more than double the maternal mortality rate in Saudi Arabia and Canada, and more than triple the rate in the United Kingdom.

It is not entirely clear why this has happened, although on explanation seems to be an increase in the number of pregnant women who have diseases that contribute to a higher-risk pregnancy, such as hypertension and diabetes. In other words, the very fact that we are becoming less healthy as adults may be playing a role in putting women at higher risk of death associated with pregnancy.