Despite Progress, Half a Million Women Still Die in Childbirth Annually

From Medscape Medical News
Megan Brooks

April 15, 2010 — A report released this week provides some sobering statistics on global maternal and infant mortality rates: an estimated 350,000 to 500,000 women still die in childbirth each year, 3.6 million newborns die in the first month of life, and an additional 5.2 million children die before the age of 5 years.

It will take an infusion of cash — about $20 billion annually — and widespread adoption of known and proven therapies and preventive measures to substantially reduce maternal and child deaths worldwide, according to the report, released ahead of a June meeting in Canada of world leaders at which maternal and child health problems will take center stage.

The new report, discussed Wednesday at the United Nations, comes from members of Countdown to 2015, a global scientific and advocacy group formed in 2005 to track global progress in reducing maternal, newborn, and child deaths — 2 of the Millennium Development Goals set by 189 member nations of the UN General Assembly in 2000.

Although considerable progress has been made toward meeting other Millennium Development Goals, the 2 goals on maternal and child survival have lagged behind, the report states. Progress on curbing maternal and infant mortality has been particularly slow in sub-Saharan Africa and South Asia.

According to the United Nations Children's Fund, 135 countries have child mortality rates of less than 40 per 1000 live births or have a rate reduction sufficient to meet the goal of two-thirds reduction by 2015. However, at this time, 39 countries show insufficient progress, and 18 show no progress or worsening child mortality rates.

Countdown to 2015 focuses on 68 countries, most in Africa, which together account for 92% of maternal, newborn, and child deaths. Members of the group held discussions with world leaders at the United Nations in New York April 14 to focus attention on the toll of maternal and child mortality and to advance an action plan.

At the meeting, US Department of Health and Human Services Secretary Kathleen Sebelius said: "This is one of the greatest human rights issues of our times. The hundreds of thousands of deaths each year among women due to complications of pregnancy and childbirth, the devastating lifelong consequences among millions more, and the millions of children who will die from preventable causes, are among our greatest moral and development challenges, and they highlight the world's lingering inequity."

"Because we know what causes these deaths and what would prevent them, major progress is possible," Jennifer Bryce, EdD, MEd, a child health researcher at Johns Hopkins University, Baltimore, Maryland, and a member of Countdown to 2015, noted in a prepared statement. "The Countdown analysis provides a road map, helping countries focus on their own data and take action to meet their specific needs."

"This is a multi-layered problem that can be addressed with a combination of many, very simple interventions," stated Flavia Bustreo, MD, director of the World Health Organization's Partnership for Maternal, Newborn & Child Health, a group of more than 300 organizations, foundations, institutions, and countries that is one of the leaders in the effort to cut maternal and infant mortality rates.

"No single intervention is sufficient," added Zulfiqar Bhutta, MD, PhD, from Pakistan's Aga Khan University and cochair of Countdown to 2015. "What is required is a seamless continuum of care including family planning, breastfeeding, hand washing, skilled attendance at delivery, and childhood immunizations. There are multiple therapies and practices that have been proven to save lives, and the use of national data can prioritize which ones will make the biggest difference in the shortest time."

Although donor countries have increased their funding for maternal, newborn, and child health by almost 100%, to $4 billion a year from 2003 to 2007, the funding gap will be about $20 billion per year between 2011 and 2015, which includes both maternal and child health programs and the cost of improving health systems. A financing task force created in 2008 is working to increase funding to help close the gap, the report notes.

A related report published in The Lancet this week found accelerated decreases in maternal mortality in China, Egypt, Ecuador, and Bolivia. Secretary Sebelius commented at the April 14 UN meeting: "This week's Lancet article suggests that in many parts of the world, we are making some progress in saving women's lives. It is up to us in this room to escalate our efforts and accelerate sustainable progress toward Millennium Development Goals 4 and 5."

In a letter posted on the Partnership for Maternal, Newborn & Child Health Web site, Dr. Bustreo echoed these sentiments: "The Lancet has published an important article...reporting significant progress in reducing the unacceptably high number of maternal deaths in many low income countries. Although debate may continue about the numbers, it is clear that the new estimates offer hope at last that the lives of women are finally being counted and that our collective actions are starting to reduce this tragedy in the new millennium. These encouraging results are no reason for complacency. Now is the time to redouble our efforts."

However, The Lancet study also found surprising increases in maternal mortality in the United States, Canada, and Denmark, which may be partially explained by changes in documentation of pregnancy-related deaths in at least one of these countries.

In a telephone interview with Medscape Ob/Gyn & Women's Health, Renee Brown-Bryant, MSW, associate director of heath communications in the Division of Reproductive Health at the Centers for Disease Control and Prevention, Atlanta, Georgia, said caution is needed in interpreting these new US data.

"One thing to consider," she said, "is that states are required to put a checkbox on death certificates to see if a woman was pregnant at the time of her death. You're going to have a check in the box, in some states, if, for example, the coroner says the woman was pregnant when there was a fatal accident and that may or may not be pregnancy related."

In the United States, Ms. Brown-Bryant noted, "we've seen a drop (in maternal mortality) near the end of the twentieth century but we didn't see a continued drop. We have not had the decline that we would want to have, but some people would say where we are is a far cry from where we were 100 years ago, and even 35 years ago."