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Posts Tagged ‘new estimates’

In April, the Lancet published new maternal mortality estimates (out of the Institute for Health Metrics and Evaluation) that showed a significant reduction in global maternal deaths, shaking up the global health community’s understanding of the global burden of the issue–and providing new hope. The report also illustrated the important links between HIV/AIDS and maternal mortality.

In the wake of the Lancet report, maternal health professionals from various organizations engaged in robust dialogue (like this one) about measurement methodologies–and raised questions about when the World Health Organization would release their estimates and how they might differ from the IHME estimates.

On September 15th, WHO, UNICEF, UNFPA, and the World Bank released their new maternal mortality estimates in a report, Trends in maternal mortality. Their report also showed a significant drop in maternal deaths—a 34% decrease between 1990 and 2008.

Excerpt from the WHO press release:

“The new estimates show that it is possible to prevent many more women from dying. Countries need to invest in their health systems and in the quality of care.

‘Every birth should be safe and every pregnancy wanted,’ says Thoraya Ahmed Obaid, the Executive Director of UNFPA. ‘The lack of maternal health care violates women’s rights to life, health, equality, and non-discrimination. MDG5 can be achieved,’ she adds, ‘but we urgently need to address the shortage of health workers and step up funding for reproductive health services’…”

More highlights from the report:

  • Ten out of 87 countries with maternal mortality ratios equal to or over 100 in 1990, are on track with an annual decline of 5.5% between 1990 and 2008. At the other extreme, 30 made insufficient or no progress since 1990.
  • The study shows progress in sub-Saharan Africa where maternal mortality decreased by 26%.
  • In Asia, the number of maternal deaths is estimated to have dropped from 315 000 to 139 000 between 1990 and 2008, a 52% decrease.
  • 99% of all maternal deaths in 2008 occurred in developing regions, with sub-Saharan Africa and South Asia accounting for 57% and 30% of all deaths respectively.

Click here to read the press release and here to read the full report.

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The controversial research reporting unexpected gains in maternal health, published April 12 in the Lancet, has triggered rigorous debate about the measurement tools used to count maternal deaths globally and at a country level. The paper, Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5, was written by Chris Murray and his team of researchers at the Institute for Health Metrics and Evaluation. The study found a dramatic reduction in the number of women dying from pregnancy complications between 1980 and 2008–and these findings have triggered both celebration and skepticism within the global health community. Some global health leaders are cheering the global progress toward MDG5 indicated by the research. Some are expressing cautious optimism. Others are challenging the paper’s methodology, asking whether it really signals big gains in the struggle against global maternal mortality or just flawed means of estimating how many women are dying.

On June 5th, the Lancet published a reply from Chris Murray in which he addresses some of the concerns voiced by his fellow global health researchers regarding the methodology of the study.

“We appreciate the rich set of letters in response to our paper on maternal mortality. The authors of the letters raise many important points, but we focus our short response on four larger themes that have been raised.

The country graphs in the webappendix to our paper show all the available data points for each country and our best estimates based on these data and the modelling strategy. In the case of the Philippines, Indonesia, Burkina Faso, and Peru, the correspondents have noted that our data-points derived from the analysis of sibling histories in household surveys are different from published figures from the same surveys. The differences stem from two sources. First, we correct for problems of survivor bias in sibling histories, following the published methods of Gakidou and Kingand Obermeyer and colleagues...”

Read the full reply by Chris Murray on the Lancet Online. Be sure to take a look at some of the critiques of the study–linked on the right panel next to Murray’s reply.

For more on this topic, take a look at a recent post, New Maternal Mortality Estimates Published in the Lancet: What’s the Buzz?, on the Maternal Health Task Force’s new MedScape Blog, GlobalMama.


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Dr. Fred Sai is co-host of Women Deliver 2010, former reproductive health and HIV/AIDS advisor to the Ghanaian government, and has spent 40 years working to improve the health of women and children in Ghana and throughout Africa.  In his June 2nd blog post, A New Role For Africans in Maternal Health, on the ONE Blog, Dr. Sai comments on the new maternal mortality estimates published in the Lancet that show a dramatic reduction in global maternal deaths–and asks questions about why Africa (as a whole) has not seen these same reductions. He also expresses confidence that a shift in approach (described in his post) will lead to major improvements in the health of women and children throughout Africa.

The ONE Blog

“…It is an unfortunate truth that progress for the world at large does not necessarily mean progress for Africa. In 1980, almost a quarter of maternal deaths occurred in African countries. Today that figure has doubled to more than half. All but one of the 30 countries with the worst maternal mortality statistics are in Africa. And while countries like Ghana and Rwanda have seen a steady decline in maternal deaths over the past 15 years, others such as Malawi, Lesotho, Zimbabwe, Nigeria and Cote d’Ivoire actually have higher maternal mortality rates than they did in 1990.

Addressing maternal mortality in Africa is complex and challenging. Our countries face increasing rates of HIV, entrenched and debilitating poverty, food shortages, weak education and health care systems, problematic governance, corruption, and civil conflict. These are huge issues in their own right, but they also have significant impact on maternal, newborn and child health. The challenges, however, are not the whole story…”

Read the full post, A New Role For Africans in Maternal Health.

For additional reactions to the Lancet publication from other leaders in the maternal health field, click here.

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On Wednesday, the Columbia Journalism Review published a thoughtful analysis of how the media is covering the new global maternal mortality estimates published in the Lancet on Monday. The piece provides a good overview of  how a handful of major news organizations are choosing to frame the story–raising questions about why some organizations  are choosing to focus on the content of the Lancet paper, while others ere focusing more on the ‘side story’ of a group of maternal health advocates who apparently pressured the Lancet not to publish the paper ( at least not to publish it yet). The Columbia Journalism Review analysis concludes that, overall,  the reporting on this story has been “simple” and “narrowly focused.”

“…A slew of news articles this week have focused on two recent reports about the number of women who die during pregnancy or in childbirth around the world every year.

The reports don’t exactly agree, and with public health experts and heads of state meeting at the United Nations this week to discuss maternal and child health issues, it is no surprise that some squabbling over the data has emerged. Unfortunately, reporters have not provided much detail or clarity about either the squabbling or the data…”

Read the full analysis here.

What do you think about how the media is covering this story?

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Several leading media outlets are covering the news of dramatic global declines in maternal deaths–and raising questions about why a group of women’s health advocates pressured the Lancet to delay publishing the findings…

The New York Times

“…The study cited a number of reasons for the improvement: lower pregnancy rates in some countries; higher income, which improves nutrition and access to health care; more education for women; and the increasing availability of “skilled attendants” — people with some medical training — to help women give birth. Improvements in large countries like India and China helped to drive down the overall death rates.

But some advocates for women’s health tried to pressure The Lancet into delaying publication of the new findings, fearing that good news would detract from the urgency of their cause, Dr. Horton said in a telephone interview…”

Read the full story, Maternal Deaths Decline Sharply Across the Globe, on NYTimes.com.

The New York Times Freakonomics Blog

The New York Times Freakonomics Blog also had something to say about this story and provided some background information on the history of maternal mortality–including a reference to the contributions to maternal health of Ignatz Semmelweis, the Hungarian physician who discovered that the incidence of puerperal fever could be drastically reduced with basic hand washing (ie. Medical students needed to wash their hands between cutting open cadavers and delivering babies!!).

Read the full post, Who’s Not Happy About a Falling Maternal Death Rate?, on the New York Times Freakonomics Blog.

Also see stories from the Associated Press, Lancet reports drops in maternal childbirth deaths, says it was pressured not to publish story; and from the Washington Post, Fewer Women Dying in Childbirth, Study Says.

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Sarah Boseley reflects on the new maternal mortality estimates published today in the Lancet. She talks with Chris Murray , Director of the Institute for Health Metrics and Evaluation (IHME) and Professor of Global Health at the University of Washington, about his research–and raises tough questions regarding the implications of the new data. For example: “Does it mean we need more money for maternal health or less?”

 Sarah Boseley’s Global Health Blog

“…It’s remarkable news – and all the more remarkable because it’s been happening without anyone realising it. It’s like waking up and finding somebody has demolished the ugly old building across the road and planted trees instead. Hard to believe the scenery has changed quite so dramatically. The new optimistic outlook will take some getting used to. This is what Dr Murray told me.

The whole community has been living off 500,000 women dying a year for the last 30 years. That’s fed a sense of almost pessimism that it is difficult to change maternal mortality.

Murray and colleagues have got new data, that has not been systematically put together in the past, and new tools…”

Read the full story, Saving Women’s Lives in Childbirth–It’s More Possible Than We Thought.

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Horton comments on the new study, Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5, published today in the Lancet Online First, that suggests a dramatic reduction in global maternal mortality between 1980 and 2008. Horton describes additional significant findings in the paper–aside from the overall drop in maternal deaths. He also outlines five lessons to be learned from this paper. 

 The Lancet

“…What lessons can be drawn from these new data? First, the latest figures are, globally, good news. The provide robust reason for optimism. More importantly, these numbers should now act as a catalyst, not a brake, for accelerated action on MDG-5, including scaled-up resource commitments. Investment incontrovertibly saves the lives of women during pregnancy. 

       Second, the intimate connection between HIV and maternal health is now explicitly laid bare. Such an association, including tuberculosis, has been gaining important recent ground. This latest evidence therefore supports growing calls to integrate maternal and child survival programmes into vertical funding mechanisms for the MDGs, such as the Global Fund to fight AIDS, Tuberculosis, and Malaria…”

Read the full commentary, Maternal mortality: Surprise, hope and urgent action.

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