New targets for maternal survival

CLARA CALVERT: In this session, we will discuss the current targets which have bee set for maternal health and then, look at what the new targets for maternal survivor will be post 2015. The Millennium Development Goals are eight international development goals. Maternal health is tied up in several of these goals. It is the goal of MDG 5, with the target of decreasing the maternal mortality ratio by 75% between 1990 and 2015, as well as ensuring universal access to reproductive health care for all woman. Maternal health can also be linked to a number of the other Millennium Development Goals, including poverty reduction, female empowerment, and infectious diseases, as women die from diseases such as malaria when they are pregnant.

So have we made progress in MDG 5? Globally, the maternal mortality ratio dropped by 45% between 1990 and 2013, from 380 to 210 maternal deaths per 100,000 live births. However, this still falls far short of the MDG target to reduce the maternal mortality ratio by 3/4 by 2015. And there’s certainly still substantial progress to make, with other indicators showing that only half of women in developing regions receive the recommended health care during pregnancy.

Some countries are on track to achieve MDG 5. One example is Egypt, where the maternal mortality ratio has declined by 62%, from 120 maternal deaths per 100,000 live births in 1990, to only 45 maternal deaths per 100,000 live births in 2013, as shown by the red line on this graph. We’ve seen a corresponding increase in skilled birth attendants, shown by the green line on the graph, from 35% in 1988, to 79% in 2008 and then, the contraceptive prevalence rate, shown in blue, from 31% in 1988 to 60% in 2008.

There are a number of factors which are thought to have contributed to this decline in maternal mortality in Egypt, including increase in utilisation of care, provider training, introduction of standards of care, facility upgrades, and public awareness campaigns. Some of these interventions were specifically targeted to maternal services, and some were wider programmes aimed at the health system as a whole. However, a cautionary note– Egypt is now facing new challenges with respect to maternal health, in particular, overmedicalisation, with, for example, C-section rates rising from 4.6% of births in the five years preceding 1992, to 50% in 2014, and also has a growing private sector.

So as we approach the end of the Millennium Development Goals, it is clear that while there’s been some progress, there’s still a lot of work to be done in the area of maternal health. In April 2014, UN agencies, donors, country stakeholders, and other development partners met for a consultation on targets and strategies for Ending Preventable Maternal Mortality, EPMM, and agreed that by 2030, the average maternal mortality ratio should be less than 70 maternal deaths per 100,000 live births. Additionally, it was agreed that no country should have a maternal mortality ratio greater than 140.

It has additionally been stated that the ultimate goal is an effective end to preventable maternal mortality by 2035, with a global target of no more than 50 maternal deaths for every 100,000 lives births. This graph shows us the progress we’ve been making in bringing down maternal mortality. The thick pink line shows the current downward trajectory we are on. We can see that for 2015, the predicted MMR remains much higher than the target MMR for Millennium Development Goal five, as indicated by the star. The dashed pink shows the accelerated trajectory we will need to aim for in order to reach the 2030 global target average of an MMR less than 70.

If we can reach this trajectory and continue it beyond 2030, then by 2035, we would expect the global MMR to be less than 50 per 100,000 live births, which is equivalent to the high-end MMR for the Organisation for Economic Cooperation and Development countries, in 2010. Now, under the leadership of the United , Nations stakeholders from around the world are working to finalise the next global development framework. The Sustainable Development Goals are expected to set the agenda for development programmes and policies around the world when MDGs expire in 2015. As of July 2014, the draft SDG framework included 17 goals, including goal three, a broad health goal to ensure healthy lives and promote well-being for all ages.

This goal is expected to encompass that outlined on the previous slide, to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. There will be further information provided on the SDGs in week six of the course.