The global decline in maternal mortality has stalled

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According to a grim report released on Wednesday by the World Health Organization and other UN agencies, although maternal mortality has declined worldwide from 2000 to 2020, nearly 800 women still die from pregnancy-related complications every day.

Despite early improvements in maternal health during the 20-year period, progress has stalled in many areas, and maternal mortality has risen sharply in recent years in Latin America, the Caribbean and, perhaps surprisingly, in Europe and North America. .

Most maternal deaths are still concentrated in poor countries and war-torn areas. Girls and women are most at risk in sub-Saharan Africa, where 70 percent of global maternal deaths occur. A 15-year-old girl in this area has a 1 in 40 risk of dying from a pregnancy-related cause.

Maternal mortality is also more common in countries facing humanitarian crises such as Yemen, Syria and Afghanistan, where there are 551 maternal deaths per 100,000 live births – more than double the world average rate of 223 per 100,000.

Overall, there were an estimated 287,000 maternal deaths worldwide in 2020, a decrease from 309,000 deaths in 2016 and 446,000 deaths in 2000, but one less than expected. WHO expects the global maternal mortality rate to be less than 70 deaths per 100,000 live births by 2030.

The report defines maternal mortality as deaths during pregnancy or childbirth, or up to six weeks after the termination of pregnancy. This category also includes deaths due to unsafe and illegal abortions, which account for up to 10 percent of maternal deaths worldwide.

According to Dr. Anshu Banerjee, Assistant Director-General for Universal Health Coverage at WHO, an estimated 270 million women worldwide do not have access to modern family planning methods, and nearly half of all pregnancies globally are unplanned.

There are 73 million abortions annually, about half of which are unsafe, he said. “When they are performed under unsafe conditions, mortality from bleeding, infection and other adverse events will increase,” Dr. Banerjee said.

The epidemic may also have contributed to the frequent maternal deaths, as pregnancy puts otherwise young and healthy women at high risk for severe disease. But the new report does not fully capture the impact of Covid, as low-income and developing countries have been slow to count maternal deaths from Covid.

In the United States, maternal deaths increased rapidly during the pandemic. According to data from the US Government Accountability Office, in 2021, hundreds of thousands of deaths are due to pregnancy complications, exacerbated by COVID infections.

But while the pandemic may have contributed to maternal deaths around the world, it “doesn’t explain the stagnation we’re seeing,” Dr. said Jenny Cresswell, an epidemiologist at the WHO and one of the authors of the new report.

Maternal mortality rates were cut by at least half in 75 countries between 2000 and 2015, but progress has stalled in much of the world since then, he and his colleagues found.

The exceptions were Australia and New Zealand and the WHO’s Central and Southern Asia Region. Between 2016 and 2020, there was a significant reduction in maternal mortality rates in those regions by 35 percent and 16 percent, respectively.

Improvements in India, Pakistan, and Bangladesh followed efforts to increase the number of women giving birth in primary health care facilities or hospitals with skilled attendants in remote areas, providing women with access to more comprehensive care if complications arise. Was able to refer to.

In contrast, maternal mortality increased by 17 percent in Europe and North America between 2016 and 2020, and by 15 percent in Latin America and the Caribbean, the WHO found.

The United States and Puerto Rico were among eight countries and territories that experienced a significant increase in maternal deaths from 2000 to 2020. (The other countries on that list are Venezuela, Cyprus, Greece, Mauritius, Belize, and the Dominican Republic.)

Among wealthy industrialized nations, the United States has the highest maternal mortality rate. According to the WHO, the rate nearly doubled between 2000 and 2020, to 21 deaths per 100,000 live births in 2020, or one in 5,000, from 12 deaths per 100,000 in 2000, or 1 in 10,000.

Racial disparities, as well as social and economic disparities, drive those mortality rates.

According to the Centers for Disease Control and Prevention, whose own figures put the US maternal mortality rate for 2020 at 23.8 per 100,000, the risk is almost three times higher for black women than for white women, at 55.3 per 100,000, whose mortality rate is 19.1. per 100,000. Native American women also have a much higher risk of dying during and after pregnancy than white women.

The leading causes of maternal death worldwide are complications from severe bleeding, high blood pressure, infection and unsafe abortion. Underlying conditions such as HIV/AIDS and malaria can also be aggravated by pregnancy.

Most of these deaths are preventable if women had access to quality health care and could plan and time their pregnancies. But in addition to limited access to contraception, nearly one-third of women have no access to good antenatal care during pregnancy, the report found.

“In theory, we know what to do,” Dr. Banerjee said. “It is whether there is political will by the partners and local governments to allocate funds to it.”

Access to health care is limited for many women in low-income countries, and especially in remote areas. There is a shortage of medical personnel, which are unevenly distributed between cities and rural areas.

In addition, families face high out-of-pocket costs to obtain care, which may include paying travel expenses and purchasing medical supplies.

“For some people, this means they will have to sell their livelihood, livestock or land, and they risk falling into poverty,” Dr Banerjee said. “This can result in them not actually seeking care, and this puts the woman at serious risk.”

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