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Maternal and Child Health Journal
Published in: Maternal and Child Health Journal 2/2012

Open Access 01-02-2012

Why Aren’t There More Maternal Deaths? A Decomposition Analysis

Authors: John A. Ross, Ann K. Blanc

Published in: Maternal and Child Health Journal | Issue 2/2012

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Abstract

Globally, the number of maternal deaths remains large, and the risk per birth is high in the developing world. Deaths declined between 1990 and 2008, despite the 42% increase in women. We decompose selected determinants to help explain the decline. Numbers of women, births, and fertility rates come from the UN; maternal mortality ratios are from the UN and from Hogan et al. Decomposition isolates the effects of additional women, decreases in fertility, and declines in mortality ratios, also in rates. Women aged 15–49 increased by 42%, but births remained constant due to declining fertility rates. The fertility decline alone averted approximately 1.7 million deaths, 1990–2008. The risk per birth (MMR) also fell, adding to the decline in the number of deaths. Exceptional declines occurred in the maternal mortality rate. Sub-Saharan Africa has experienced minimal declines in deaths, due to increases in women and small declines in fertility and mortality. The growing numbers of women have made international efforts to reduce the number of maternal deaths ever more challenging. Comparatively little attention has been given to the offsetting effect of the historic fertility declines in the developing world, and hence a flat trend in births. The maternal mortality ratio has also fallen, reflecting the success of direct maternal health efforts. Programs that provide couples with the means to control their fertility can reinforce fertility declines. These programs are companions to ongoing, direct measures to reduce the risk of death once pregnant.
Footnotes
1
The World Health Organization defines a maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
 
2
Family planning use may also reduce maternal mortality through lengthening the duration of intervals between births although there is little evidence on this point.
 
3
Previous studies attempting to quantify the effect of contraceptive use on maternal mortality, published mostly in the 1980s, were hampered by a lack of data. At the time, many countries had no reliable estimates of maternal mortality at all and time series data were virtually non-existent except in a few cases. While maternal mortality data are still inadequate and are often unreliable, considerable effort has been put into data improvements over the last 15 years—through the inclusion of the topic in population surveys, censuses, and other data collection methods—and global and regional estimates have now been produced for several time periods.
 
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Stover, J., & Ross, J. (2010). How increased contraceptive use has reduced maternal mortality. Maternal and Child Health Journal, 14(5), 687–695.PubMedCrossRef
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Fortney, J. A. (1987). The importance of family planning in reducing maternal mortality. Studies in Family Planning, 18(2), 109–114.PubMedCrossRef
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Metadata
Title
Why Aren’t There More Maternal Deaths? A Decomposition Analysis
Authors
John A. Ross
Ann K. Blanc
Publication date
01-02-2012
Publisher
Springer US
Published in
Maternal and Child Health Journal / Issue 2/2012
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI
https://doi.org/10.1007/s10995-011-0777-x

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