Diversity and divergence: the dynamic burden of poor maternal health

This is the first article published in the 2016 Lancet Maternal Health Series. The article focuses on the patterns and trends in maternal health worldwide.BackgroundEach year, around 210 million women become pregnant and 140 million newborn babies are born.  This vast scale makes the survival of pregnant women and newborn babies essential concerns for Sustainable Development Goal 3 (SDG3): Ensure healthy lives and promotion of well-being for all, at all ages. The report emphasises that while there has been some progress in improving maternal and newborn survival, improvements have been patchy. There is increased diversity in the scale and causes of maternal death and ill health, which in turn contributes to widening inequities and levels of death seen in the most vulnerable populations. This diversity presents major challenges for policies and programmes working to match need with care and to achieving SDG3.The key messages include:

• Between 1990 and 2015, the global maternal mortality ratio (MMR) fell by 44%.  This is a significant achievement, considering that there has been an increase in the number of pregnancies and births over the same timeframe 
• Despite overall improvements, there is wide geographic variation both within and between populations.  The gap between the group of countries with the lowest and highest maternal deaths doubled between 1990 and 2013
• In terms of the global burden of poor maternal health, there has been a shift from preventable maternal deaths to increasingly varied ill health issues, including an increased impact of non-communicable diseases on maternal health
• Four major transitions have contributed to the diversity and shifts in the burden of maternal health worldwide: demographic (population structure), epidemiological (disease patterns), socioeconomic and environmental
• For high income countries, the overall maternal death ratio is 46 times lower than the highest figure in sub-Saharan Africa, at 12 deaths per 100,000 live births, compared to 546 deaths per 100,000 live births
• In 2015, 66% of global maternal deaths were accounted for in the sub-Saharan Africa region alone
• Within populations, there are vulnerable sub-groups that may experience minimal improvements over time and experience limited future progress
• Countries where health systems are weakest, or presenting challenging contexts e.g. fragile states, have the highest burden of maternal death and ill health
• There is a need to reform health systems to meet the needs of vulnerable groups rather than simply improving coverage using current strategies

ConclusionThe paper concludes that while considerable gains in maternal health have been achieved, they have not been equitable between regions or countries. Increasing diversity in the levels, causes and distribution of maternal health present challenges to programmes and policies intending to meet diverse needs across diverse settings. This requires essential improvements in health information systems, as well as reliable population-based data on poor maternal health separated by key vulnerability indicators, in order to monitor widening gaps, and inform policies and programmes accordingly. To read the full article free after registration, click here.Graham, W., Woodd, S., Byass, P., Filippi V., Gon, G., Virgo, S., Chou, C., Hounton, S., Lozano, R., Pattinson, R., Singh, S. (2016). Diversity and divergence: the dynamic burden of poor maternal health. The Lancet, Maternal Health Series Paper1, (Early online publication).