MATERNAL MORTALITY FIGURES SUBSTANTIALLY UNDERESTIMATED, NEW WHO/UNICEF STUDY SAYS
Press Release
H/2896*
ICEF/1829
MATERNAL MORTALITY FIGURES SUBSTANTIALLY UNDERESTIMATED, NEW WHO/UNICEF STUDY SAYS
19960205 GENEVA, 5 February (WHO) -- A major new study carried out by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) indicates that maternal mortality has been substantially underestimated in the past, and that there are nearly 80,000 more pregnancy-related deaths per year than previously reported. According to the study, some 585,000 maternal deaths occur in the world each year, 99 per cent of them in developing countries.Most maternal deaths (55 per cent) occur in Asia which accounts for 61 per cent of the world's births. However, Africa, which has 20 per cent of the world's births, accounts for 40 per cent of all maternal deaths. By contrast, developed countries, with 11 per cent of all births, have less than 1 per cent of total maternal deaths.
In developing countries as a whole, the risk of death during pregnancy or childbirth (maternal mortality ration) ranges from just under 200 per 100,000 live births in Latin America and the Caribbean to over 870 per 100,000 in Africa. The regions with the highest ratios, over 1,000 per 100,000 live births, are in eastern and western Africa. The risk of pregnancy-related death is 100 times greater in sub-Saharan Africa than in Europe.
In only five subregions of the world -- northern Africa, southern Africa, eastern Asia, Central and South America -- are the new estimates of maternal mortality lower than those available from the earlier studies and then only marginally so. Everywhere else the risk of pregnancy-related death is considerably higher according to these new calculations. The situation is particularly disquieting in eastern, middle and western Africa and where the earlier estimates appear to have underestimated maternal mortality by nearly one third.
The lowest national figures are found in Norway, Sweden and Switzerland, while at the other extreme, the highest are in Sierra Leone, 1,800 per 100,000 liver births, and in Afghanistan, 1,700. This means that in Sierra Leone one woman in every seven dies of pregnancy-related complications.
_---------_ * Press Release H/2983, dated 11 January, should have been numbered H/2893.
- 2 - Press Release H/2896 ICEF/1829 5 February 1996
"Maternal mortality is a particularly sensitive indicator of inequity", says Dr. Susan Holck of the WHO Reproductive Health Programme. "Maternal mortality offers a litmus test of the status of women, their access to health care and the adequacy of the health-care system in responding to their needs."
It is extremely difficult to assess levels of maternal mortality. Maternal deaths tend to be under-reported even in developed countries with vital registration systems. Where such counting of births and deaths does not happen, estimating maternal mortality is particularly difficult. It requires
knowledge about deaths of women of reproductive age (15-49 years), the cause of death and also whether the woman was pregnant at the time of death.
Yet few counties count births and deaths; even fewer register the cause of death; and fewer still systematically note pregnancy status on the death form. Cause of death is routinely reported for only 78 counties or areas (for comparison, there are 190 WHO Member States) covering approximately 37 per cent of the world's population.
"These new maternal mortality estimates -- a result of a two-year concerted effort -- clearly underscore the fact that the world's response must be adjusted to the scale of the problem", says Dr. France Donnay, Women's Health Adviser of UNICEF.
A variety of innovative approaches have been devised to overcome the absence of data in countries with poor or non-existent vital registration. They range from household surveys to detailed investigations into the causes of all deaths of women of reproductive age. Multiple sources of information - - civil registers, health facility records, community leaders, religious authorities, undertakers -- are used to identify all deaths. Subsequently, interviews with household members and health-care providers are used to classify deaths as pregnancy-related or otherwise. Because of the complexity and costs involved only a few developing countries have managed to carry out these detailed investigations at the national level.
The new estimates of maternal mortality have been developed by WHO and UNICEF using a dual strategy. This involved adjusting available country figures to account for under-reporting and using a simple model to generate estimates for countries with no data or where there is concern about the adequacy of officially reported estimates.
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