| Resumen: |
Five years remain until the 2015 deadline to
achieve the Millennium Development Goals (MDG)
adopted at the 2000 Millennium Summit. There are
two targets for assessing progress in improving
maternal health (MDG 5): reducing the maternal
mortality ratio (MMR) by three quarters between
1990 and 2015, and achieving universal access to
reproductive health by 2015. Closer examination
of maternal mortality levels is needed to inform
planning of reproductive health programmes, to
guide advocacy efforts and research at the national
and international levels, and to inform decisionmaking
for the achievement of MDG 5. To be useful
for the latter purpose, the country estimates must be
internationally comparable.
It has been a challenge to assess the extent of
progress towards the MDG 5 target due to the
lack of reliable and accurate data on maternal
mortality – particularly in developing-country
settings where maternal mortality is high. The World
Health Organization (WHO), the United Nations
Children’s Fund (UNICEF), and the United Nations
Population Fund (UNFPA) have previously published
internationally comparable estimates of maternal
mortality for 1990, 1995, and 2000. In 2005,
the three agencies, along with The World Bank,
developed country, regional, and global estimates
and made the first attempt to assess trends in MMR
at the regional and global levels. As an update to
this ongoing effort, the four agencies now present
the global maternal mortality data for 2008 as well
as for years 1990, 1995, 2000, and 2005. These
estimates revise and improve upon the earlier
methodology used.
An estimated 358 000 maternal deaths occurred
worldwide in 2008, a 34% decline from the
levels of 1990. Despite this decline, developing
countries continued to account for 99% (355 000)
of the deaths. Sub-Saharan Africa and South Asia
accounted for 87% (313 000) of global maternal
deaths. Eleven countries including Afghanistan,
Bangladesh, the Democratic Republic of the Congo,
Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan,
Sudan, and the United Republic of Tanzania,
comprised 65% of all maternal deaths in 2008.
Overall, it was estimated that there were 42 000
deaths due to HIV/AIDS among pregnant women
in 2008. About half of those were assumed to be
maternal. The contribution of HIV/AIDS was highest
in sub-Saharan Africa where 9% of all maternal
deaths were due to HIV/AIDS. Without these deaths,
the MMR for sub-Saharan Africa would have been
580 maternal deaths per 100 000 live births instead
of 640.
The MMR in 2008 was highest in developing regions
(290) in stark contrast to developed regions (14) and
countries of the Commonwealth of Independent
States (40). Among developing regions, sub-Saharan
Africa had the highest MMR at 640 maternal deaths
per 100 000 live births in 2008, followed by South
Asia (280), Oceania (230), South-Eastern Asia (160),
North Africa (92), Latin America and the Caribbean
(85), Western Asia (68), and Eastern Asia (41). Fortyfive
countries had high estimated MMR (MMR ≥300)
with four countries (Afghanistan, Chad, Guinea-
Bissau, and Somalia), having extremely high MMR
(MMR ≥1000). Outside of sub-Saharan Africa, the
seven countries with high MMR were: Afghanistan
(1400), the Lao People’s Democratic Republic (580),
Nepal (380), Timor-Leste (370), Bangladesh (340),
Haiti (300), and Cambodia (290).
During the period 1990–2008, 147 countries
experienced a decline in MMR, 90 of which showed
a decline of 40% or more. In two countries, there
was no estimated change in MMR, while 23
countries had an increase.
The adult lifetime risk of maternal death (the
probability that a 15-year-old female will die
eventually from a maternal cause) as measured in
2008 is highest in sub-Saharan Africa (at 1 in 31),
followed by Oceania (1 in 110), and South Asia
(1 in 120), while developed regions had the smallest
lifetime risk (1 in 4300). Of the 172 countries and
territories, Afghanistan had the highest estimated
lifetime risk of 1 in 11. |
