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