Fewer women dying during pregnancy, childbirth

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A new study published online earlier this week by the British medical journal The Lancet suggests that the number of women dying during pregnancy or childbirth has dropped by more than one third in the past three decades, from half a million annual deaths in 1980 to 343,000 as of 2008. The study, sponsored by the Bill & Melinda Gates Foundation and conducted by researchers from the University of Washington in Seattle and University of Queensland in Brisbane, finds that, across the 181 countries studied, the maternal mortality rate has slowly been dropping—by about 1.4% per year since 1990.

Yet, while these findings are certainly encouraging—combating maternal and infant mortality is a long-standing public health goal around the globe—they seem to contradict results of a 2009 World Health Organization (WHO) report indicating a lack of improvement in maternal survival. Speaking with Reuters in May of last year, the WHO director of health statistics stated grimly, “Maternal mortality is stuck at what it was in 1990.” Yet, the WHO is expected to release new data later this year, according to the New York Times, and researchers say that these latest findings are based on more sophisticated analysis as well as significantly more information than previous studies—including a report published in The Lancet in 2007 suggesting that there were 535,900 pregnancy- and childbirth-related deaths among women in 2005.

For this research, investigators at the University of Washington’s Institute for Health Metrics and Evaluation and the University of Queensland collected roughly three times as much data as previous efforts, the Times reports. Though only 23 of the 181 countries studied are currently on track with the United Nations’ millennium development goal of reducing worldwide maternal mortality by 75% between 1990 and 2015, study authors point out that there has been some significant improvement in the developing world. Globally the maternal mortality ratio—or number of maternal deaths per 100,000 live births—dropped from 320 in 1990 to 251 in 2008. (It had been 422 in 1980, according to the new report.) In Bolivia, the change was more drastic: the number of maternal deaths per every 100,000 live births fell from 439 in 1990 to 180 in 2008. Elsewhere there were several examples of similarly significant improvements: in China, the ratio dropped from 87 in 1990 to 40 in 2008; in Vietnam, it fell from 158 to 64 during the time studied; and in Morocco it fell from 384 to 124.

What’s more, the authors point out, many reported deaths during pregnancy or childbirth may be attributable to HIV, which is hampering progress in the further reduction of maternal morality. In 2008, 61,400 maternal deaths were related to HIV, representing one in every five maternal deaths, according to the study. Without the impact of HIV, researchers estimate that there would have been 281,500 maternal deaths in 2008.

Yet, despite a better understanding of contributing factors to maternal mortality, and many promising drops in maternal deaths, researchers did note significant increases during the period studied: in Afghanistan, which currently has the highest maternal mortality ratio, the number of mothers dying during pregnancy or childbirth grew from 1,261 per 100,000 live births in 1990 to 1,575 per 100,000 live births in 2008. In Zimbabwe, the ratio grew from 232 in 1990 to 624 in 2008; and in Ivory Coast, it jumped from 580 in 1990 to 944 less than two decades later.

Increasing maternal mortality wasn’t only seen in the developing world however. While the U.S. ranks 40th out of the 181 countries studied in terms of maternal mortality ratio, according to this latest research, the number of American women dying while pregnant or giving birth increased significantly during the period studied. In 1990, the mortality ratio was 12 per 100,000 live births; by 2008, it was 17. That figure is even higher than the 13.3 deaths per 100,000 live births reported by Amnesty International earlier this year. As Jennifer Block reported for TIME in March, that study, based on data from the Centers for Disease Control and Prevention as well as other sources, found that “black women in the U.S. are nearly four times as likely as white women to die from pregnancy-related causes.” The report added to previous concern about maternal mortality in the U.S. raised by an inquiry in California suggesting that maternal mortality rates had tripled there in the previous decade.

The U.S. is not the only developed nation to see an increase in maternal deaths, according to the new study. Canada saw a slight increase in mortality ratio during the period studied—from 6 maternal deaths per 100,000 live births in 1990 to 7 in 2008—and Norway had a similar increase, from 7 in 1990 to 8 in 2008.

While there is an alarming trend in maternal deaths in the U.S., overall this latest report shows tremendous improvement in this critical health measure around the world. As Dr. Richard Horton, editor of the Lancet wrote in an editorial accompanying the new study, “[t]he latest figures are, globally, good news. They provide robust reason for optimism.” Yet, as Horton points out, this dramatic departure from previous findings inevitably comes with some controversy. To begin with, despite broad approval of the methodology and study’s findings, it became clear during the peer review process that not everyone was on page with all aspects of the research, a chafing that Horton says points to a growing need to understand “varying approaches to measuring maternal mortality.” Finding a way to place this data in context and assess how it may be reconciled with that from previous research should be a central priority in the global health community, he says.

Yet perhaps most controversial—more so even than the findings themselves—was the fact that several advocacy groups contacted the journal hoping to delay publication of the findings out of concern that they might damage outreach and education efforts, or lull politicians and health officials into a sense of complacency about the issue. Despite the good intentions of those advocacy groups, Horton wrote, efforts to “slow the pace of scientific discussion for political considerations” is ultimately more damaging than constructive. These findings should be viewed as evidence that efforts to improve education and maternal health care, among other initiatives, are actually having an effect, he argues, and should be embraced as a component of a clearer picture of maternal mortality around the world. “Women have long delivered for society, and, slowly, society is at last delivering for women,” he writes. “This is a moment to accelerate—and celebrate.”

Read a Q & A with study author Dr. Christopher Murray.

To access and download data from the new study, visit the report page at the University of Washington’s Institute for Health Metrics and Evaluation.