Global and national maternal mortality targets for the Sustainable Development Goals

By: Rima Jolivet, Maternal Health Technical Director, Maternal Health Task Force; Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

This post originally appeared on the MHTF Blog.

There has been some confusion recently about the Sustainable Development Goals (SDG) target for reducing global maternal mortality. The SDG global target is to reduce the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030. In addition to this global target, there are separate country-level targets: The primary national target is that by 2030, every country should reduce its MMR by at least two-thirds from its 2010 baseline. The secondary target, which applies to countries with the highest maternal mortality burdens, is that no country should have an MMR greater than 140 deaths per 100,000 live births by 2030.


SDG 3.1 global target:

By 2030, reduce the global maternal mortality ratio to less than 70 deaths per 100,000 live births.

EPMM national targets:

Primary target: By 2030, all countries should reduce their maternal mortality ratios by at least two-thirds from their 2010 baseline.

Secondary target: By 2030, no country should have a maternal mortality ratio greater than 140 deaths per 100,000 live births.


These global and national maternal mortality targets, developed by a group of technical experts through extensive consultations with global and country-level stakeholders, were published in a 2015 report, Strategies for Ending Preventable Maternal Mortality (EPMM Strategies). The EPMM Strategies report fed into the development of the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030 (Global Strategy), a framework for achieving the Sustainable Development Goals related to the health of women, children and adolescents.

Understanding the distinction between the global and national targets is crucial. The global target alone is not useful for instituting country-level change. Countries need to set national targets to drive reduction in maternal deaths and thus contribute to meeting the global goal. The primary national target—that every country should reduce its MMR by at least two-thirds from its 2010 baseline levels—takes each country’s different starting point into account while still holding countries accountable for their own progress toward the common SDG goal.

Each country has a unique starting point: a different baseline MMR and epidemiological risk profile, different health system capacity and resources and a different sociopolitical climate for work on reducing maternal mortality. These differences are reflected in the wide disparities in MMR among countries around the globe. National MMRs range from 3 deaths per 100,000 live births in Finland, Greece, Iceland and Poland to 1,360 deaths per 100,000 live births in Sierra Leone. This disparity illustrates that, unfortunately, a woman’s risk of maternal death depends largely on where she lives. Thus, the secondary national target—that no country should have a national MMR greater than 140 deaths per 100,000 live births  by 2030—was proposed as an important mechanism for reducing extreme inequities in global maternal survival.

Ten Countries with the highest MMRs (per 100,000 live births) Ten Countries with the lowest MMRs   (per 100,000 live births)
Sierra Leone (1,360) Finland (3)
Central African Republic (882) Greece (3)
Chad (856) Iceland (3)
Nigeria (814) Poland (3)
South Sudan (789) Austria (4)
Somalia (732) Belarus (4)
Liberia (725) Czech Republic (4)
Burundi (712) Italy (4)
Gambia (706) Kuwait (4)
Democratic Republic of the Congo (693) Sweden (4)
Data are estimates from “Trends in maternal mortality: 1990 to 2015” Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division

For countries with current MMRs less than 10 deaths per 100,000 live births, measuring a two-thirds reduction is not feasible due to statistical limitations. Those countries with low MMRs should therefore focus on reducing internal inequities. National-level MMRs can hide disparities within countries: Women of low socioeconomic status, belonging to certain racial or ethnic groups and those living in rural areas, for example, are often at greatest risk of dying from pregnancy or childbirth-related causes. Therefore, all countries are called to focus on eliminating inequities among sub-populations under the new goals framework.

The SDG 3.1 global target of less than 70 deaths per 100,000 live births represents an ambitious reduction in the global burden of maternal mortality from the current global MMR. Data from the Global Burden of Disease Study 2015 estimates that the global MMR is 196 deaths per 100,000 live births. According to the World Health Organization, the global MMR is even higher, at approximately 216 deaths per 100,000 live births. But the global goal is achievable if all countries contribute to the global average by accelerating their national reduction of preventable maternal deaths by at least two-thirds and ensuring that no woman and no country is left behind, a key theme of the Global Strategy.

Clearly, we all still have far to go in order to achieve both the global and national targets for maternal mortality. Reducing the global MMR to less than 70 deaths per 100,000 live births through national reduction of MMR by two-thirds in all countries by 2030 and reducing inequities in maternal survival within and among countries will be challenging; but with continued investment in maternal health research, programs and policy at the global, national and local levels, we can work together to end preventable maternal mortality across the globe.

Learn more by checking out these resources:

Strategies Toward Ending Preventable Maternal Mortality (EPMM) | World Health Organization

Ending Preventable Maternal Mortality | MHTF Project

Strategies Toward Ending Preventable Maternal Mortality (EPMM) Under the Sustainable Development Goals Agenda | MHTF Blog

A common monitoring framework for ending preventable maternal mortality, 2015–2030: phase I of a multi-step process | BMC Pregnancy and Childbirth

Ending preventable maternal and newborn mortality and stillbirths | BMJ

Universal health coverage and gender

By Stacy Lu

This interview with Kiley Workman Diop originally appeared on the blog for Systems for Improved Access to Pharmaceuticals and Services (SIAPS), a program funded by USAID and implemented by Management Sciences for Health. This interview has been edited for length. 

Kiley Workman Diop is a Technical Advisor for SIAPS, and Stacy Lu is a Technical Writer for SIAPS.

A pharmacist with a client at the pharmacy for the the Hospital Notre Dame des Palmistes, Ile la Tortue, Haiti  (Photo credit: Jean Jacques Augustin)

How does attention to gender figure into the work SIAPS does in strengthening pharmaceutical systems?
In public health, when you’re designing an intervention you’re trying to think broadly about what’s going to help the whole population. But you also need to pay special attention to vulnerable groups, including groups that derive their vulnerability from their gender. In a broad sense, it’s about equity—if half the population (whether men or women, boys or girls) isn’t being served appropriately by our interventions, that dilutes SIAPS’s success and we miss out on achieving equitable access to medicines and services that help save lives. We have to think about gender to ensure equitable access to quality care.

Continue reading “Universal health coverage and gender”

PROGRES requires a keen gender perspective

By Alanna Savage and Andrew Gaydos

Alanna Savage is a Senior Communications Specialist for the FCI Program of Management Sciences for Health (MSH) and Andrew Gaydos is a Project Support Associate at MSH.

In our ambitious vision to reach all people, everywhere, it is ever more necessary to examine the varying life experiences–the actual realities–of the people whose health we work to improve. Part of this examination requires a critical look at how gender plays out in the power structures of society, the daily lives of people, and more concretely, in the “who, what, where, when, and how” of health-seeking behavior and access to essential reproductive and maternal health care.

Maternal mortality in Mali remains high–587 women die for every 100,000 live births–but only 28 percent of sexually active women of reproductive have satisfied their demand for family planning.  Women and girls continue to confront widespread sexual and gender-based violence, including female genital mutilation/cutting (FGM/C); in 2015, about 126,000 women and girls received prevention services, protection, and care related to FGM/C. And thanks to the work of the FCI Program of MSH, traditional and faith leaders are advocating for family planning and coming together to provide support to survivors of gender-based violence and to identify early warning signs of imminent violence.

Gender inequality undoubtedly plays a role in high maternal mortality and unmet need for family planning and the continuance of sexual and gender-based violence. As long as women and girls must continue to fight for equal voice and an equal share of opportunity and power, their lives and health will remain under threat. Gender influences health outcomes, access to care, providers’ treatment of patients, relationships among health workers and supervisors, and health career barriers and opportunities.

Photo by Catherine Lalonde

Continue reading “PROGRES requires a keen gender perspective”

We are fearless. #FearlessFeb

Photo by Joey O’Loughlin

We are celebrating Fearless February to rally the global community around advocacy for reproductive, maternal, newborn, child and adolescent health!

This month, the FCI Program of MSH will feature stories about fearless champions, powerful evidence, and advocacy wins from the Rights & Realities archive. Follow #FearlessFeb on Twitter and Facebook to read the story of the day.

Join us on Twitter and Facebook, and tell us:
What makes you fearless? What does “fearless” mean to you?
Subscribe to Rights & Realities (on the homepage, right column) to receive emails of new posts.

 

Trump’s global gag rule silences doctors and midwives and harms their patients

By Catharine Taylor

Catharine Taylor is Vice President for health programs at Management Sciences for Health. This post originally appeared on STAT News

Midwifery students in Sierra Leone, which has one of the highest maternal mortality rates in the world. Funding for safe pregnancy and delivery worldwide is threatened by President Trump’s reinstatement of the global gag rule. (Photo by MARCO LONGARI/AFP/Getty Images)

President Trump’s reinstatement of the Mexico City Policy, better known as the global gag rule, came as no surprise to anyone working in the field of global health. We have been through this before — in 1984, when the policy was first put into effect by President Reagan, and then in 1993, 2001, and 2009, when it was repealed, reinstated, and repealed again.

The Mexico City Policy is called a gag rule because it limits not just what organizations and health providers do but what they are permitted to say. It prevents foreign organizations that receive US government funding from performing abortions — even if they are using funds from non-US government sources and even if abortion is completely legal in their countries.

The global gag rule also steps right between a woman and her doctor, nurse, or midwife, preventing these frontline health providers from telling their patients about the full, legal range of health options available to them. It forbids trusted advisers from giving honest, comprehensive health advice and information. I started my career as a nurse-midwife, and then worked in maternal and newborn health programs in Africa and Asia, so I know what this will mean for the lives and health of women and their families. Continue reading “Trump’s global gag rule silences doctors and midwives and harms their patients”

Counting every maternal death: Strengthening maternal mortality surveillance and response in the Caribbean

By Aishling Thurow

Aishling Thurow is a Project Support Associate at Management Sciences for Health. 

Every maternal death must be documented to prevent the next one. In the Caribbean, where 175 women die for every 100,000 live births (WHO, 2015), understanding the reasons they died is essential to preventing more unnecessary maternal deaths in the future.

In 2013, the World Health Organization developed guidelines for maternal death surveillance and response (MDSR) to capture the number and systemic causes of maternal deaths and to strengthen policies and programs that will better respond to maternal health needs.

Delegates and organizers from the Technical Consultation on the Maternal Death Surveillance and Response Guidelines (MDSR): Region of the Americas. Dec. 9, 2016. Montego Bay, Jamaica. Photo by Aishling Thurow/MSH

In December 2016, the Latin America and Caribbean Regional Task Force for the Reduction of Maternal Mortality (GTR for its Spanish acronym), of which MSH is an Executive Committee member, hosted a technical consultation on guidelines for maternal death surveillance and response systems in the Caribbean. Held in Montego Bay, Jamaica, the workshop welcomed 20 delegates−Ministry of Health officials, as well as prominent maternal mortality surveillance experts−from Jamaica, Belize, Suriname, Guyana, and Trinidad and Tobago. The workshop aimed to strengthen maternal mortality surveillance and response systems in the sub-region, to improve maternal mortality data quality, and to strengthen policy development and implementation capacities at the national level.

Continue reading “Counting every maternal death: Strengthening maternal mortality surveillance and response in the Caribbean”

Emergency contraception is a simple part of post-rape care: Why is it not routinely provided?

By Melissa Garcia and Sarah Rich

Melissa Garcia is Senior Technical Officer for the International Consortium for Emergency Contraception and Sarah Rich is Senior Program Officer at Women’s Refugee Commission. This post originally appeared on the blog for the Sexual Violence Research Initiative

Emergency contraception (EC) can reduce the risk of pregnancy after unprotected sex, including in cases of sexual violence. Global guidance is clear that EC should be offered to women and girls within 120 hours of sexual violence to prevent the traumatic consequences of pregnancy resulting from rape.

Yet women and girls who have experienced unprotected sex, including through sexual violence, do not routinely have access to EC. The global aid communities must work together to increase access to EC for sexual violence survivors around the world, including for women and girls who are the most marginalized, like those living in crisis-affected settings. A range of strategies can be implemented to improve access to EC. Further research is also needed to identify, evaluate, and invest in new and innovative solutions. Continue reading “Emergency contraception is a simple part of post-rape care: Why is it not routinely provided?”

Webinar presentation – Misoprostol for PPH: Innovations for Impact

On December 15, MSH, Gynuity Health Projects and Jhpiego hosted a one-hour webinar to share innovations – interventions, technologies, and distribution approaches – that have the potential to increase access to and use of misoprostol for postpartum hemorrhage (PPH), the leading cause of maternal death. This webinar:

  • Highlighted innovative ways that countries are expanding access to and use of misoprostol for PPH
  • Showed how successful innovations can be scaled up for national impact

PRESENTERS
Esther Azasi
Knowledge Management Specialist & Associate Program Manager, One Million Community Health Workers Campaign-Millennium Promise, Ghana

Holly Anger
Program Associate, Gynuity Health Projects, USA

Gail Webber
Saving Mothers Project, Mara Region, Tanzania and University of Ottawa, Canada

Partamin Manalai
Monitoring, Evaluation and Research Director, Jhpiego, Afghanistan

MODERATOR
Shafia Rashid
Senior Technical Advisor, FCI Program of Management Sciences for Health (MSH)

Listen to the webinar and download the presentation slides here.

Misoprostol for postpartum hemorrhage: Empowering health workers to save lives

Shafia Rashid is a Senior Technical Advisor for the FCI Program of Management Sciences for Health.

In Senegal, approximately 1,800 women lose their lives every year while giving birth. The major cause of these deaths is uncontrolled bleeding after childbirth, or postpartum hemorrhage (PPH). More than half of Senegalese women live in rural areas and have limited access to well-equipped health facilities that can prevent or treat many of these deaths. Many women give birth, attended by matrones or volunteer birth attendants, in maternity huts. Recognized as essential health care providers by their communities, matrones have some formal training and are now registered with the Ministry of Health (MoH).

To effectively prevent or treat PPH, women need access to uterus-contracting drugs, or uterotonics, such as oxytocin or misoprostol. The recommended uterotonic, injectable oxytocin, requires cold storage and technical skill to administer. Misoprostol is a safe and effective alternative where oxytocin isn’t available or feasible; it doesn’t need refrigeration and is easy to use—particularly important features for use in remote, rural areas.

From 2013 to 2014, the Government of Senegal’s Direction of Reproductive Health and Child Survival, in partnership with USAID and Gynuity Health Projects, examined the use of misoprostol (600 mcg oral) or oxytocin (10 UI) via Uniject® for prevention of PPH at the community level. Matrones were trained to assist with deliveries and administer the designated intervention. According to the study, both misoprostol and oxytocin in Uniject® were equally effective and safe in preventing PPH, and matrones  posted at the health huts were capable of administering the medicine they were assigned. Continue reading “Misoprostol for postpartum hemorrhage: Empowering health workers to save lives”