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BACKGROUND:
The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.
METHODS:
We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.
FINDINGS:
292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.
INTERPRETATION:
Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.
Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013 / Kassebaum, Nicholas J.; Bertozzi-Villa, Amelia; Coggeshall, Megan S.; Shackelford, Katya A.; Steiner, Caitlyn; Heuton, Kyle R.; Gonzalez-Medina, Diego; Barber, Ryan; Huynh, Chantal; Dicker, Daniel; Templin, Tara; Wolock, Timothy M.; Ozgoren, Ayse Abbasoglu; Abd-Allah, Foad; Abera, Semaw Ferede; Abubakar, Ibrahim; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Adou, Arsène Kouablan; Adsuar, José C.; Agardh, Emilie E.; Akena, Dickens; Alasfoor, Deena; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Raghib; Al Kahbouri, Mazin J.; Alla, François; Allen, Peter J.; Almazroa, Mohammad A.; Alsharif, Ubai; Alvarez, Elena; Alvis-Guzmán, Nelson; Amankwaa, Adansi A.; Amare, Azmeraw T.; Amini, Hassan; Ammar, Walid; Antonio, Carl A.T.; Anwari, Palwasha; Ärnlöv, Johan; Arsenijevic, Valentina S. Arsic; Artaman, Ali; Asad, Majed Masoud; Asghar, Rana J.; Assadi, Reza; Atkins, Lydia S.; Badawi, Alaa; Balakrishnan, Kalpana; Basu, Arindam; Basu, Sanjay; Beardsley, Justin; Bedi, Neeraj; Bekele, Tolesa; Bell, Michelle L.; Bernabe, Eduardo; Beyene, Tariku J.; Bhutta, Zulfiqar; Abdulhak, Aref Bin; Blore, Jed D.; Basara, Berrak Bora; Bose, Dipan; Breitborde, Nicholas; Cárdenas, Rosario; Castañeda-Orjuela, Carlos A.; Castro, Ruben Estanislao; Catalá-López, Ferrán; Cavlin, Alanur; Chang, Jung-Chen; Che, Xuan; Christophi, Costas A.; Chugh, Sumeet S.; Cirillo, Massimo; Colquhoun, Samantha M.; Cooper, Leslie Trumbull; Cooper, Cyrus; Da Costa Leite, Iuri; Dandona, Lalit; Dandona, Rakhi; Davis, Adrian; Dayama, Anand; Degenhardt, Louisa; De Leo, Diego; Del Pozo-Cruz, Borja; Deribe, Kebede; Dessalegn, Muluken; Deveber, Gabrielle A.; Dharmaratne, Samath D.; Dilmen, Uʇur; Ding, Eric L.; Dorrington, Rob E.; Driscoll, Tim R.; Ermakov, Sergei Petrovich; Esteghamati, Alireza; Faraon, Emerito Jose A.; Farzadfar, Farshad; Felicio, Manuela Mendonca; Fereshtehnejad, Seyed-Mohammad; De Lima, Graça Maria Ferreira; Forouzanfar, Mohammad H.; França, Elisabeth B.; Gaffikin, Lynne; Gambashidze, Ketevan; Gankpé, Fortuné Gbètoho; Garcia, Ana C.; Geleijnse, Johanna M.; Gibney, Katherine B.; Giroud, Maurice; Glaser, Elizabeth L.; Goginashvili, Ketevan; Gona, Philimon; González-Castell, Dinorah; Goto, Atsushi; Gouda, Hebe N.; Gugnani, Harish Chander; Gupta, Rahul; Gupta, Rajeev; Hafezi-Nejad, Nima; Hamadeh, Randah Ribhi; Hammami, Mouhanad; Hankey, Graeme J.; Harb, Hilda L.; Havmoeller, Rasmus; Hay, Simon I.; Pi, Ileana B. Heredia; Hoek, Hans W.; Hosgood, H Dean; Hoy, Damian G.; Husseini, Abdullatif; Idrisov, Bulat T.; Innos, Kaire; Inoue, Manami; Jacobsen, Kathryn H.; Jahangir, Eiman; Jee, Sun Ha; Jensen, Paul N.; Jha, Vivekanand; Jiang, Guohong; Jonas, Jost B.; Juel, Knud; Kabagambe, Edmond Kato; Kan, Haidong; Karam, Nadim E.; Karch, André; Karema, Corine Kakizi; Kaul, Anil; Kawakami, Norito; Kazanjan, Konstantin; Kazi, Dhruv S.; Kemp, Andrew H.; Kengne, Andre Pascal; Kereselidze, Maia; Khader, Yousef Saleh; Khalifa, Shams Eldin Ali Hassan; Khan, Ejaz Ahmed; Khang, Young-Ho; Knibbs, Luke; Kokubo, Yoshihiro; Kosen, Soewarta; Defo, Barthelemy Kuate; Kulkarni, Chanda; Kulkarni, Veena S.; Kumar, G. Anil; Kumar, Kaushalendra; Kumar, Ravi B.; Kwan, Gene; Lai, Taavi; Lalloo, Ratilal; Lam, Hilton; Lansingh, Van C.; Larsson, Anders; Lee, Jong-Tae; Leigh, James; Leinsalu, Mall; Leung, Ricky; Li, Xiaohong; Li, Yichong; Li, Yongmei; Liang, Juan; Liang, Xiaofeng; Lim, Stephen S.; Lin, Hsien-Ho; Lipshultz, Steven E.; Liu, Shiwei; Liu, Yang; Lloyd, Belinda K.; London, Stephanie J.; Lotufo, Paulo A.; Ma, Jixiang; Ma, Stefan; Machado, Vasco Manuel Pedro; Mainoo, Nana Kwaku; Majdan, Marek; Mapoma, Christopher Chabila; Marcenes, Wagner; Marzan, Melvin Barrientos; Mason-Jones, Amanda J.; Mehndiratta, Man Mohan; Mejia-Rodriguez, Fabiola; Memish, Ziad A.; Mendoza, Walter; Miller, Ted R.; Mills, Edward J.; Mokdad, Ali H.; Mola, Glen Liddell; Monasta, Lorenzo; De La Cruz Monis, Jonathan; Hernandez, Julio Cesar Montañez; Moore, Ami R.; Moradi-Lakeh, Maziar; Mori, Rintaro; Mueller, Ulrich O.; Mukaigawara, Mitsuru; Naheed, Aliya; Naidoo, Kovin S.; Nand, Devina; Nangia, Vinay; Nash, Denis; Nejjari, Chakib; Nelson, Robert G.; Neupane, Sudan Prasad; Newton, Charles R.; Ng, Marie; Nieuwenhuijsen, Mark J.; Nisar, Muhammad Imran; Nolte, Sandra; Norheim, Ole F.; Nyakarahuka, Luke; Oh, In-Hwan; Ohkubo, Takayoshi; Olusanya, Bolajoko O.; Omer, Saad B.; Opio, John Nelson; Orisakwe, Orish Ebere; Pandian, Jeyaraj D.; Papachristou, Christina; Park, Jae-Hyun; Paternina Caicedo, Angel J.; Patten, Scott B.; Paul, Vinod K.; Pavlin, Boris Igor; Pearce, Neil; Pereira, David M.; Pesudovs, Konrad; Petzold, Max; Poenaru, Dan; Polanczyk, Guilherme V.; Polinder, Suzanne; Pope, Dan; Pourmalek, Farshad; Qato, Dima; Quistberg, D. Alex; Rafay, Anwar; Rahimi, Kazem; Rahimi-Movaghar, Vafa; Ur Rahman, Sajjad; Raju, Murugesan; Rana, Saleem M.; Refaat, Amany; Ronfani, Luca; Roy, Nobhojit; Pimienta, Tania Georgina Sánchez; Sahraian, Mohammad Ali; Salomon, Joshua A.; Sampson, Uchechukwu; Santos, Itamar S.; Sawhney, Monika; Sayinzoga, Felix; Schneider, Ione J.C.; Schumacher, Austin; Schwebel, David C.; Seedat, Soraya; Sepanlou, Sadaf G.; Servan-Mori, Edson E.; Shakh-Nazarova, Marina; Sheikhbahaei, Sara; Shibuya, Kenji; Shin, Hwashin Hyun; Shiue, Ivy; Sigfusdottir, Inga Dora; Silberberg, Donald H.; Silva, Andrea P.; Singh, Jasvinder A.; Skirbekk, Vegard; Sliwa, Karen; Soshnikov, Sergey S.; Sposato, Luciano A.; Sreeramareddy, Chandrashekhar T.; Stroumpoulis, Konstantinos; Sturua, Lela; Sykes, Bryan L.; Tabb, Karen M.; Talongwa, Roberto Tchio; Tan, Feng; Teixeira, Carolina Maria; Tenkorang, Eric Yeboah; Terkawi, Abdullah Sulieman; Thorne-Lyman, Andrew L.; Tirschwell, David L.; Towbin, Jeffrey A.; Tran, Bach X.; Tsilimbaris, Miltiadis; Uchendu, Uche S.; Ukwaja, Kingsley N.; Undurraga, Eduardo A.; Uzun, Selen Begüm; Vallely, Andrew J.; Van Gool, Coen H.; Vasankari, Tommi J.; Vavilala, Monica S.; Venketasubramanian, N.; Villalpando, Salvador; Violante, Francesco S.; Vlassov, Vasiliy Victorovich; Vos, Theo; Waller, Stephen; Wang, Haidong; Wang, Linhong; Wang, Xiao Rong; Wang, Yanping; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G.; Westerman, Ronny; Wilkinson, James D.; Woldeyohannes, Solomon Meseret; Wong, John Q.; Wordofa, Muluemebet Abera; Xu, Gelin; Yang, Yang C.; Yano, Yuichiro; Yentur, Gokalp Kadri; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa Z.; Yu, Chuanhua; Jin, Kim Yun; El Sayed Zaki, Maysaa; Zhao, Yong; Zheng, Yingfeng; Zhou, Maigeng; Zhu, Jun; Zou, Xiao Nong; Lopez, Alan D.; Naghavi, Mohsen; Murray, Christopher J.L.; Lozano, Rafael. - In: THE LANCET. - ISSN 0140-6736. - STAMPA. - 384:9947(2014), pp. 980-1004. [10.1016/S0140-6736(14)60696-6]
Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013
Kassebaum, Nicholas J.;Bertozzi Villa, Amelia;Coggeshall, Megan S.;Shackelford, Katya A.;Steiner, Caitlyn;Heuton, Kyle R.;Gonzalez Medina, Diego;Barber, Ryan;Huynh, Chantal;Dicker, Daniel;Templin, Tara;Wolock, Timothy M.;Ozgoren, Ayse Abbasoglu;Abd Allah, Foad;Abera, Semaw Ferede;Abubakar, Ibrahim;Achoki, Tom;Adelekan, Ademola;Ademi, Zanfina;Adou, Arsène Kouablan;Adsuar, José C.;Agardh, Emilie E.;Akena, Dickens;Alasfoor, Deena;Alemu, Zewdie Aderaw;Alfonso Cristancho, Rafael;Alhabib, Samia;Ali, Raghib;Al Kahbouri, Mazin J.;Alla, François;Allen, Peter J.;Almazroa, Mohammad A.;Alsharif, Ubai;Alvarez, Elena;Alvis Guzmán, Nelson;Amankwaa, Adansi A.;Amare, Azmeraw T.;Amini, Hassan;Ammar, Walid;Antonio, Carl A. T.;Anwari, Palwasha;Ärnlöv, Johan;Arsenijevic, Valentina S. Arsic;Artaman, Ali;Asad, Majed Masoud;Asghar, Rana J.;Assadi, Reza;Atkins, Lydia S.;Badawi, Alaa;Balakrishnan, Kalpana;Basu, Arindam;Basu, Sanjay;Beardsley, Justin;Bedi, Neeraj;Bekele, Tolesa;Bell, Michelle L.;Bernabe, Eduardo;Beyene, Tariku J.;Bhutta, Zulfiqar;Abdulhak, Aref Bin;Blore, Jed D.;Basara, Berrak Bora;Bose, Dipan;Breitborde, Nicholas;Cárdenas, Rosario;Castañeda Orjuela, Carlos A.;Castro, Ruben Estanislao;Catalá López, Ferrán;Cavlin, Alanur;Chang, Jung Chen;Che, Xuan;Christophi, Costas A.;Chugh, Sumeet S.;Cirillo, Massimo;Colquhoun, Samantha M.;Cooper, Leslie Trumbull;Cooper, Cyrus;Da Costa Leite, Iuri;Dandona, Lalit;Dandona, Rakhi;Davis, Adrian;Dayama, Anand;Degenhardt, Louisa;De Leo, Diego;Del Pozo Cruz, Borja;Deribe, Kebede;Dessalegn, Muluken;Deveber, Gabrielle A.;Dharmaratne, Samath D.;Dilmen, Uʇur;Ding, Eric L.;Dorrington, Rob E.;Driscoll, Tim R.;Ermakov, Sergei Petrovich;Esteghamati, Alireza;Faraon, Emerito Jose A.;Farzadfar, Farshad;Felicio, Manuela Mendonca;Fereshtehnejad, Seyed Mohammad;De Lima, Graça Maria Ferreira;Forouzanfar, Mohammad H.;França, Elisabeth B.;Gaffikin, Lynne;Gambashidze, Ketevan;Gankpé, Fortuné Gbètoho;Garcia, Ana C.;Geleijnse, Johanna M.;Gibney, Katherine B.;Giroud, Maurice;Glaser, Elizabeth L.;Goginashvili, Ketevan;Gona, Philimon;González Castell, Dinorah;Goto, Atsushi;Gouda, Hebe N.;Gugnani, Harish Chander;Gupta, Rahul;Gupta, Rajeev;Hafezi Nejad, Nima;Hamadeh, Randah Ribhi;Hammami, Mouhanad;Hankey, Graeme J.;Harb, Hilda L.;Havmoeller, Rasmus;Hay, Simon I.;Pi, Ileana B. Heredia;Hoek, Hans W.;Hosgood, H. Dean;Hoy, Damian G.;Husseini, Abdullatif;Idrisov, Bulat T.;Innos, Kaire;Inoue, Manami;Jacobsen, Kathryn H.;Jahangir, Eiman;Jee, Sun Ha;Jensen, Paul N.;Jha, Vivekanand;Jiang, Guohong;Jonas, Jost B.;Juel, Knud;Kabagambe, Edmond Kato;Kan, Haidong;Karam, Nadim E.;Karch, André;Karema, Corine Kakizi;Kaul, Anil;Kawakami, Norito;Kazanjan, Konstantin;Kazi, Dhruv S.;Kemp, Andrew H.;Kengne, Andre Pascal;Kereselidze, Maia;Khader, Yousef Saleh;Khalifa, Shams Eldin Ali Hassan;Khan, Ejaz Ahmed;Khang, Young Ho;Knibbs, Luke;Kokubo, Yoshihiro;Kosen, Soewarta;Defo, Barthelemy Kuate;Kulkarni, Chanda;Kulkarni, Veena S.;Kumar, G. Anil;Kumar, Kaushalendra;Kumar, Ravi B.;Kwan, Gene;Lai, Taavi;Lalloo, Ratilal;Lam, Hilton;Lansingh, Van C.;Larsson, Anders;Lee, Jong Tae;Leigh, James;Leinsalu, Mall;Leung, Ricky;Li, Xiaohong;Li, Yichong;Li, Yongmei;Liang, Juan;Liang, Xiaofeng;Lim, Stephen S.;Lin, Hsien Ho;Lipshultz, Steven E.;Liu, Shiwei;Liu, Yang;Lloyd, Belinda K.;London, Stephanie J.;Lotufo, Paulo A.;Ma, Jixiang;Ma, Stefan;Machado, Vasco Manuel Pedro;Mainoo, Nana Kwaku;Majdan, Marek;Mapoma, Christopher Chabila;Marcenes, Wagner;Marzan, Melvin Barrientos;Mason Jones, Amanda J.;Mehndiratta, Man Mohan;Mejia Rodriguez, Fabiola;Memish, Ziad A.;Mendoza, Walter;Miller, Ted R.;Mills, Edward J.;Mokdad, Ali H.;Mola, Glen Liddell;Monasta, Lorenzo;De La Cruz Monis, Jonathan;Hernandez, Julio Cesar Montañez;Moore, Ami R.;Moradi Lakeh, Maziar;Mori, Rintaro;Mueller, Ulrich O.;Mukaigawara, Mitsuru;Naheed, Aliya;Naidoo, Kovin S.;Nand, Devina;Nangia, Vinay;Nash, Denis;Nejjari, Chakib;Nelson, Robert G.;Neupane, Sudan Prasad;Newton, Charles R.;Ng, Marie;Nieuwenhuijsen, Mark J.;Nisar, Muhammad Imran;Nolte, Sandra;Norheim, Ole F.;Nyakarahuka, Luke;Oh, In Hwan;Ohkubo, Takayoshi;Olusanya, Bolajoko O.;Omer, Saad B.;Opio, John Nelson;Orisakwe, Orish Ebere;Pandian, Jeyaraj D.;Papachristou, Christina;Park, Jae Hyun;Paternina Caicedo, Angel J.;Patten, Scott B.;Paul, Vinod K.;Pavlin, Boris Igor;Pearce, Neil;Pereira, David M.;Pesudovs, Konrad;Petzold, Max;Poenaru, Dan;Polanczyk, Guilherme V.;Polinder, Suzanne;Pope, Dan;Pourmalek, Farshad;Qato, Dima;Quistberg, D. Alex;Rafay, Anwar;Rahimi, Kazem;Rahimi Movaghar, Vafa;Ur Rahman, Sajjad;Raju, Murugesan;Rana, Saleem M.;Refaat, Amany;Ronfani, Luca;Roy, Nobhojit;Pimienta, Tania Georgina Sánchez;Sahraian, Mohammad Ali;Salomon, Joshua A.;Sampson, Uchechukwu;Santos, Itamar S.;Sawhney, Monika;Sayinzoga, Felix;Schneider, Ione J. C.;Schumacher, Austin;Schwebel, David C.;Seedat, Soraya;Sepanlou, Sadaf G.;Servan Mori, Edson E.;Shakh Nazarova, Marina;Sheikhbahaei, Sara;Shibuya, Kenji;Shin, Hwashin Hyun;Shiue, Ivy;Sigfusdottir, Inga Dora;Silberberg, Donald H.;Silva, Andrea P.;Singh, Jasvinder A.;Skirbekk, Vegard;Sliwa, Karen;Soshnikov, Sergey S.;Sposato, Luciano A.;Sreeramareddy, Chandrashekhar T.;Stroumpoulis, Konstantinos;Sturua, Lela;Sykes, Bryan L.;Tabb, Karen M.;Talongwa, Roberto Tchio;Tan, Feng;Teixeira, Carolina Maria;Tenkorang, Eric Yeboah;Terkawi, Abdullah Sulieman;Thorne Lyman, Andrew L.;Tirschwell, David L.;Towbin, Jeffrey A.;Tran, Bach X.;Tsilimbaris, Miltiadis;Uchendu, Uche S.;Ukwaja, Kingsley N.;Undurraga, Eduardo A.;Uzun, Selen Begüm;Vallely, Andrew J.;Van Gool, Coen H.;Vasankari, Tommi J.;Vavilala, Monica S.;Venketasubramanian, N.;Villalpando, Salvador;VIOLANTE, FRANCESCO SAVERIO;Vlassov, Vasiliy Victorovich;Vos, Theo;Waller, Stephen;Wang, Haidong;Wang, Linhong;Wang, Xiao Rong;Wang, Yanping;Weichenthal, Scott;Weiderpass, Elisabete;Weintraub, Robert G.;Westerman, Ronny;Wilkinson, James D.;Woldeyohannes, Solomon Meseret;Wong, John Q.;Wordofa, Muluemebet Abera;Xu, Gelin;Yang, Yang C.;Yano, Yuichiro;Yentur, Gokalp Kadri;Yip, Paul;Yonemoto, Naohiro;Yoon, Seok Jun;Younis, Mustafa Z.;Yu, Chuanhua;Jin, Kim Yun;El Sayed Zaki, Maysaa;Zhao, Yong;Zheng, Yingfeng;Zhou, Maigeng;Zhu, Jun;Zou, Xiao Nong;Lopez, Alan D.;Naghavi, Mohsen;Murray, Christopher J. L.;Lozano, Rafael
2014
Abstract
BACKGROUND:
The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.
METHODS:
We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.
FINDINGS:
292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.
INTERPRETATION:
Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/520369
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