Maternal Health in the Year 2076

In 2076 we can expect to celebrate the achievement of south Asian countries reaching Millennium Development Goal 5 (a 75% fall in maternal mortality ratio from 1990; figure). This will be later than the target date of 2015, and the situation is a lot less promising for Africa.These are the implications of the recent estimates published by the UN on maternal mortality for 2005 (Oct 13, p 1311).1Hill K Thomas K AbouZahr C et al.on behalf of the Maternal Mortality Working GroupEstimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data.Lancet. 2007; 370: 1311-1319Summary Full Text Full Text PDF PubMed Scopus (357) Google Scholar, 2WHO/UNFPA/UNICEF/World BankMaternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. World Health Organization, 2007Google Scholar The most recent report is encouraging in that it attempts to wrestle with the problem of showing trends in levels of maternal mortality over time. The value of such global estimates has been challenged previously,3Hussein J Clapham S Message in a bottle: sinking in a sea of safe motherhood concepts.Health Policy. 2005; 73: 294-302Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar and their main benefit is perhaps to raise and maintain political will to commit resources to the problem.It is disappointing that trend analyses are not available at country level; for most countries, the data available are insufficient to provide useful estimates. Nevertheless, it is precisely national or subnational trends that would provide the greatest motivation to politicians, as well as providing some feedback on the success or otherwise of national programmes. So we would like to see continued investment in national and subnational measurement of levels and trends of maternal mortality.Finally, a point only partly alluded to in the estimates: owing to demographic and fertility trends (which, like maternal mortality ratios, are related to poverty), an increasing proportion of global births will be in sub-Saharan Africa, where maternal mortality is highest. This means that there is a tendency for global maternal mortality ratios to increase, even if regional ones are held constant. Thus unless substantial improvements are made regionally, we can expect progress in reducing the global maternal mortality ratio to slow down even from its current snail's pace.The authors work with Immpact, which is funded by the Bill & Melinda Gates Foundation, the UK Department for International Development, the European Commission, and USAID. Immpact is an international research programme which also provides technical assistance through its affiliate organisation, Ipact. The funders have no responsibility for the information provided or views expressed in this letter. The views expressed herein are solely those of the authors. We declare that we have no conflict of interest. In 2076 we can expect to celebrate the achievement of south Asian countries reaching Millennium Development Goal 5 (a 75% fall in maternal mortality ratio from 1990; figure). This will be later than the target date of 2015, and the situation is a lot less promising for Africa. These are the implications of the recent estimates published by the UN on maternal mortality for 2005 (Oct 13, p 1311).1Hill K Thomas K AbouZahr C et al.on behalf of the Maternal Mortality Working GroupEstimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data.Lancet. 2007; 370: 1311-1319Summary Full Text Full Text PDF PubMed Scopus (357) Google Scholar, 2WHO/UNFPA/UNICEF/World BankMaternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. World Health Organization, 2007Google Scholar The most recent report is encouraging in that it attempts to wrestle with the problem of showing trends in levels of maternal mortality over time. The value of such global estimates has been challenged previously,3Hussein J Clapham S Message in a bottle: sinking in a sea of safe motherhood concepts.Health Policy. 2005; 73: 294-302Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar and their main benefit is perhaps to raise and maintain political will to commit resources to the problem. It is disappointing that trend analyses are not available at country level; for most countries, the data available are insufficient to provide useful estimates. Nevertheless, it is precisely national or subnational trends that would provide the greatest motivation to politicians, as well as providing some feedback on the success or otherwise of national programmes. So we would like to see continued investment in national and subnational measurement of levels and trends of maternal mortality. Finally, a point only partly alluded to in the estimates: owing to demographic and fertility trends (which, like maternal mortality ratios, are related to poverty), an increasing proportion of global births will be in sub-Saharan Africa, where maternal mortality is highest. This means that there is a tendency for global maternal mortality ratios to increase, even if regional ones are held constant. Thus unless substantial improvements are made regionally, we can expect progress in reducing the global maternal mortality ratio to slow down even from its current snail's pace. The authors work with Immpact, which is funded by the Bill & Melinda Gates Foundation, the UK Department for International Development, the European Commission, and USAID. Immpact is an international research programme which also provides technical assistance through its affiliate organisation, Ipact. The funders have no responsibility for the information provided or views expressed in this letter. The views expressed herein are solely those of the authors. We declare that we have no conflict of interest.