Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group
Open accessAbstract
Background Millennium Development Goal 5 calls for a 75% reduction in the maternal mortality ratio (MMR) between 1990 and 2015. We estimated levels and trends in maternal mortality for 183 countries to assess progress made. Based on MMR estimates for 2015, we constructed projections to show the requirements for the Sustainable Development Goal (SDG) of less than 70 maternal deaths per 100,000 livebirths globally by 2030. Methods We updated the UN Maternal Mortality Estimation Inter-Agency Group (MMEIG) database with more than 200 additional records (vital statistics from civil registration systems, surveys, studies, or reports). We generated estimates of maternal mortality and related indicators with 80% uncertainty intervals (UIs) using a Bayesian model. The model combines the rate of change implied by a multilevel regression model with a time-series model to capture data-driven changes in country-specific MMRs, and includes a data model to adjust for systematic and random errors associated with different data sources. Results We had data for 171 of 183 countries. The global MMR fell from 385 deaths per 100,000 livebirths (80% UI 359-427) in 1990, to 216 (207-249) in 2015, corresponding to a relative decline of 43·9% (34·0-48·7), with 303,000 (291,000-349,000) maternal deaths worldwide in 2015. Regional progress in reducing the MMR since 1990 ranged from an annual rate of reduction of 1·8% (0·0-3·1) in the Caribbean to 5·0% (4·0-6·0) in eastern Asia. Regional MMRs for 2015 ranged from 12 deaths per 100,000 livebirths (11-14) for high-income regions to 546 (511-652) for sub-Saharan Africa. Accelerated progress will be needed to achieve the SDG goal; countries will need to reduce their MMRs at an annual rate of reduction of at least 7·5%. Interpretation Despite global progress in reducing maternal mortality, immediate action is needed to meet the ambitious SDG 2030 target, and ultimately eliminate preventable maternal mortality. Although the rates of reduction that are needed to achieve country-specific SDG targets are ambitious for most high mortality countries, countries that made a concerted effort to reduce maternal mortality between 2000 and 2010 provide inspiration and guidance on how to accomplish the acceleration necessary to substantially reduce preventable maternal deaths. Funding National University of Singapore, National Institute of Child Health and Human Development, USAID, and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.
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Clinical symptoms of infection during pregnancy are often atypical, and there is currently no unified standard for early identification and diagnosis of infection during pregnancy and postpartum period.
“However, the clinical symptoms are often atypical,1 and there is currently no unified standard for early identification and diagnosis of infection during pregnancy and postpartum period.7”
From Clinical and Pathogenic Characteristics of 45 Cases of Bloodstream Infection in Obstetrics: A Clinical Analysis (2026) · cites this paper as [7]
The Discussion addresses misclassification of maternal deaths in vital-registration data and standardizing mortality reporting, not clinical identification or diagnosis of infection. Searches for infection diagnosis and a unified standard found no passage addressing whether such a standard exists during pregnancy or postpartum. The separate statement about atypical symptoms carries citation 1, not this citation. (LLM, conf=0.75)
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Quality of care for pregnant women and newborns—the <scp>WHO</scp> vision
Tunçalp, Ӧ., Were, W., MacLennan, C., Oladapo, O., Gülmezoglu, A., Bahl, R., Daelmans, B., Mathai, M., Say, L., Kristensen, F., et al. (2015) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.13451 · Cited by 1,101 · see citing works
Self-citationObstetric transition: the pathway towards ending preventable maternal deaths
Souza, J., Tunçalp, Ö., Vogel, J., Bohren, M., Widmer, M., Oladapo, O., Say, L., Gülmezoglu, A., & Temmerman, M. (2014) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12735 · Cited by 303 · see citing works
Self-citationVan Lerberghe, W., Matthews, Z., Achadi, E., Ancona, C., Campbell, J., Channon, A., de Bernis, L., De Brouwere, V., Fauveau, V., Fogstad, H., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60919-3 · Cited by 248 · see citing works
Ending preventable maternal and newborn mortality and stillbirths
Chou, D., Daelmans, B., Jolivet, R. R., Kinney, M., & Say, L. (2015) · BMJ · doi:10.1136/bmj.h4255 · Cited by 207 · see citing works
Self-citationEnding preventable maternal deaths: the time is now
Bustreo, F., Say, L., Koblinsky, M., Pullum, T. W., Temmerman, M., & Pablos-Méndez, A. (2013) · The Lancet Global Health · doi:10.1016/s2214-109x(13)70059-7 · Cited by 109 · see citing works
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Flagged first, then by citations
Research works printed but not linked: 17
- [11]Stanton C Abderrahim N Hill K An assessment of DHS maternal mortality indicators Studies in Family Planning 2000 31 111 23 10907277
- [15]Wilmoth J A new method for deriving global estimates of maternal mortality Stat Politics Policy 2012 3 2 1 38 PMC3886639 24416714
- [16]Alkema L Zhang S Chou D Gemmill A Moller AB Ma Fat D Say L Mathers C Hogan D (under review) A Bayesian approach to the global estimation of maternal mortality This paper has been submitted as a supplement to this manuscript and will be available through Arxiv at the time of publication
- [17]Wilmoth J The lifetime risk of maternal mortality: concept and measurement Bulletin of the World Health Organization 2009 87 256 62 19551233 PMC2672571
- [18]Gelman A Hill J Data analysis using regression and multilevel/hierarchical model New York Cambridge University Press 2007
- [19]Plummer M JAGS: A Program for Analysis of Bayesian Graphical Models Using Gibbs Sampling The third international workshop on 'Distributed Statistical Computing 2003 Vienna, Austria
- [21]A Decade of Tracking Progress for Maternal Newborn and Child Survival-The2015 Report-Conference Draft Geneva World Health Organization 2015
- [22]El Arifeen S Hill K Ahsan KZ Jamil K Nahar Q Streatfield PK Maternal mortality in Bangladesh: a Countdown to 2015 country case study The Lancet 2014 384 9951 1366 74 24990814
- [27]Hanson C Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households Lancet Global Health 2015 3 7 e387 95 26004775
- [33]Souza JP Tunçalp Ö Vogel JP Bohren M Widmer M Oladapo OT Say L Gülmezoglu AM Temmerman M Obstetric transition: the pathway towards ending preventable maternal deaths BJOG 2014 121 Suppl 1 1 4 24641529
- [34]Streatfield PK Cause-specific mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites Global Health Action, [Sl] 7 10 2014 1654-9880 Available at: < http://www.globalhealthaction.net/index.php/gha/article/view/25362> Date accessed: 23 Aug. 2015 http://dx.doi.org/10.3402/gha.v7 PMC4220126 25377324 · DOI
- [35]Helleringer S Improving survey data on pregnancy-related deaths in low and middle-income countries: a validation study in Senegal Trop Med Int Health 2015 8 7 10.1111/tmi.12583 26250761 · DOI
- [37]Harvey SA Blandón YCW McCaw-Binns A Sandino I Urbina L Rodríguez C and the Nicaraguan maternal and neonatal health quality improvement group Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward Bull World Health Organ 2007 85 783 790 18038060 PMC2636500
- [38]Adegoke A Utz B Msuya SE van den Broek N Skilled Birth Attendants: who is who? A descriptive study of definitions and roles from nine Sub Saharan African countries PLoS One 2012 7 e40220 22808121 PMC3393745
- [39]Das J Holla A Das V Mohanan M Tabak D Chan B In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps Health Aff (Millwood) 2012 31 2774 2784 23213162 PMC3730274
- [40]GBD 2013 Mortality and Causes of Death Collaborators Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 Lancet 2015 1 10 385 9963 117 171 10.1016/S0140-6736(14)61682-2 25530442 PMC4340604 · DOI · Paper page
- [41]Gerland P Masquelier B Helleringer S Hogan D Mathers CD Maternal mortality estimates The Lancet 2014 384 9961 2211 25625396
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Naghavi, M., Abajobir, A. A., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S. F., Aboyans, V., Adetokunboh, O., Afshin, A., Agrawal, A., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)32152-9 · Cited by 4,821 · see citing works
Starrs, A. M., Ezeh, A. C., Barker, G., Basu, A., Bertrand, J. T., Blum, R., Coll-Seck, A. M., Grover, A., Laski, L., Roa, M., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30293-9 · Cited by 1,598 · see citing works
Self-citationMiller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., Diaz, V., Geller, S., Hanson, C., Langer, A., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31472-6 · Cited by 1,181 · see citing works
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Sedgh, G., Bearak, J., Singh, S., Bankole, A., Popinchalk, A., Ganatra, B., Rossier, C., Gerdts, C., Tunçalp, Ö., Johnson, B. R., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)30380-4 · Cited by 766 · see citing works
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Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review.
Dahab, R., & Sakellariou, D. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17124292 · Cited by 335 · see citing works
Ahmed, I., Ali, S. M., Amenga-Etego, S., Ariff, S., Bahl, R., Baqui, A. H., Begum, N., Bhandari, N., Bhatia, K., Bhutta, Z. A., et al. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30385-1 · Cited by 330 · see citing works
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Graham, W., Woodd, S., Byass, P., Filippi, V., Gon, G., Virgo, S., Chou, D., Hounton, S., Lozano, R., Pattinson, R., et al. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31533-1 · Cited by 309 · see citing works
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Black, R. E., Levin, C., Walker, N., Chou, D., Liu, L., & Temmerman, M. (2016) · The Lancet · doi:10.1016/s0140-6736(16)00738-8 · Cited by 241 · see citing works
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Meazaw, M. W., Chojenta, C., Muluneh, M. D., & Loxton, D. (2020) · PLOS ONE · doi:10.1371/journal.pone.0237600 · Cited by 105 · see citing works
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Dotse-Gborgbortsi, W., Dwomoh, D., Alegana, V., Hill, A., Tatem, A. J., & Wright, J. (2020) · BMJ Global Health · doi:10.1136/bmjgh-2019-002020 · Cited by 78 · see citing works
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Dotse-Gborgbortsi, W., Nilsen, K., Ofosu, A., Matthews, Z., Tejedor-Garavito, N., Wright, J., & Tatem, A. J. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04998-0 · Cited by 73 · see citing works
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Blencowe, H., Calvert, P., Lawn, J. E., Cousens, S., & Campbell, O. M. R. (2016) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2016.05.006 · Cited by 56 · see citing works
Anwar, J., Torvaldsen, S., Sheikh, M., & Taylor, R. (2018) · BMC Public Health · doi:10.1186/s12889-018-5363-3 · Cited by 43 · see citing works
Ajayi, A. I., & Akpan, W. (2020) · BMC Public Health · doi:10.1186/s12889-020-08512-z · Cited by 34 · see citing works
Abdu, M., Wilson, A., Mhango, C., Taki, F., Coomarasamy, A., & Lissauer, D. (2018) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.12350 · Cited by 33 · see citing works
Nathan, H. L., Vousden, N., Lawley, E., de Greeff, A., Hezelgrave, N. L., Sloan, N., Tanna, N., Goudar, S. S., Gidiri, M. F., Sandall, J., et al. (2018) · BMJ Innovations · doi:10.1136/bmjinnov-2017-000235 · Cited by 31 · see citing works
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- Authors
- Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A.-B., Gemmill, A., Fat, D. M., Boerma, T., Temmerman, M., Mathers, C., & Say, L.
- Affiliations
- University of Massachusetts Amherst (US)
- World Health Organization (CH)
- Harvard University (US)
- University of California, Berkeley (US)
- Corresponding author
- Chou, Doris
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 387
- Issue
- 10017
- Pages
- 462-474
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC5515236
- OpenAlex
- W2175954218
- Cited by
- 2,261
- References
- 5
- Citations by year
- 2026: 103 · 2025: 145 · 2024: 155 · 2023: 232 · 2022: 234 · 2021: 304 · 2020: 358 · 2019: 316 · 2018: 206 · 2017: 148 · 2016: 57 · 2015: 2
- FWCI
- 124.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion, cc-by-nc-nd)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Funders
- United States Agency for International Development
- World Health Organization
- UNICEF
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD007275)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- maternal mortality, maternal mortality ratio, Sustainable Development Goal 5, Millennium Development Goal 5, sub-Saharan Africa, high-income countries, low-income countries, maternal death, global burden of disease, maternal health policy
- MeSH terms
- Adolescent, Adult, Bayes Theorem, Asia, Eastern, Female, Humans, Maternal Mortality, Middle Aged, United Nations, United States, Global Health, Models, Statistical, Databases, Factual, Caribbean Region, Africa South of the Sahara, Live Birth, United States Agency for International Development, Young Adult, Maternal Death
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