A group of experts in the field of maternal health, led by Clara Menéndez, Director of ISGlobal's Maternal, Child and Reproductive Health Initiative, has published an opinion piece in the British Medical Journal (BMJ) warning of the worrying lack of progress in reducing preventable maternal deaths worldwide. This situation, they say, has been exacerbated by both a lack of investment and the obstacles posed by the pandemic.
Insufficient progress to meet the Sustainable Development Goals
The latest global progress report on maternal mortality from the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the United Nations Population Fund (UNFPA) shows that the global decline in maternal mortality seen earlier this century has stalled in recent years. The COVID-19 pandemic has further exacerbated the situation. In 2020, an estimated 287,000 women worldwide died from causes related to pregnancy, childbirth or the postpartum period, equivalent to about 800 maternal deaths per day.
If the rate of progress over the past five years is maintained, the maternal mortality ratio is expected to be 222 per 100,000 live births by 2030, more than three times the target set by the Sustainable Development Goals (SDGs), which aims to reduce maternal deaths to less than 70 per 100,000 live births. To achieve this target, efforts must focus on the determinants of maternal survival, particularly in countries with a high burden of mortality (95% of maternal deaths occur in low- and middle-income countries, and 70% of these are concentrated in sub-Saharan Africa).
Access to quality maternal health care and reliable data
Access to appropriate medical care during childbirth, emergency obstetric care and postpartum care is critical to preventing most maternal deaths. Although more and more deliveries are taking place in health facilities in low- and middle-income countries, this has not resulted in the expected reduction in maternal mortality, experts warn. Lack of timely access to health care, late arrival at a health facility and delays in receiving appropriate care are factors contributing to high maternal mortality. Problems with the quality of care are also recognised, such as lack of training and motivation of health workers, lack of medical resources and facilities, and lack of autonomy for women to make decisions about their medical care. "A key factor that is often overlooked is the inaccurate diagnosis of causes of maternal death, such as overdiagnosis of eclampsia or underdiagnosis of obstetric infections, which leads to inadequate clinical case management," adds Clara Menéndez.
The experts also stress the importance of improving data systems, as the countries with the highest maternal mortality rates are those with the least reliable data. They also stress the need to invest in family planning and promote gender equity, as family planning needs are still not being met, particularly in sub-Saharan Africa.
To address this global challenge, it is crucial to focus efforts on prioritising maternal health on key national and international agendas, ensuring gender equality and empowering women in decision-making, the authors say. "The lack of significant progress since the end of the Millennium Development Goals era in 2015 calls for a renewed commitment to end preventable maternal deaths and ensure a safe future for mothers and future generations," concludes Menéndez.
Menendez C, Nhampossa T, Gbeasor-Komlanvi D F, de Lauwerier V B, Gupta G, Bustreo F et al. Stalled global progress on preventable maternal deaths needs renewed focus and action; BMJ 2023; 381 :p1473. doi:10.1136/bmj.p1473