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Posts Tagged ‘The Lancet’

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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Over 3,500 maternal health providers, researchers, policymakers, and advocates from all over the world have gathered in Washington D.C. for Women Deliver 2010, a global conference focused on maternal and newborn health. Earlier today, I posted a short blog post on the MHTF Blog with highlights from day one of the conference.

The MHTF Blog

The post includes links to the announcement of the  Gates Foundation commitment to $1.5 billion in additional funding for maternal and child health (announced yesterday by Melinda Gates), a special themed issue of the Lancet dedicated to Women Deliver, the launch of the University of Oxford’s maternal health crowd-sourcing initiative, and several other announcements of major developments in the field of maternal and child health. The blog post includes several useful links for more information on each of the highlights.

Click here to read the post  on the MHTF Blog.

If you are not attending the conference but would like to participate remotely, view the live webcast here.

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In this video, Richard Horton, Editor of the Lancet, talks about the key themes of the upcoming Women Deliver conference (June 7-9)–specifically the focus on Millennium Development Goal 5, improving maternal and reproductive health.

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The symposium, Measuring the Progress on Maternal and Child Mortality: Data, Alternative Methods, and Findings, will be held on May 24th from 11:15am to 5pm at the Washington D.C. Kaiser Family Foundation office, immediately following a 9:30am policy forum on maternal and child health organized by the Kaiser Family Foundation. This all day symposium will bring together several maternal and child health experts and will be moderated by Editor-in-Chief of the Lancet, Richard Horton.

The Institute for Health Metrics and Evaluation

“…The all day event is designed to initiate vigorous scientific dialogue around the data and analytic approaches used in determining maternal and child mortality rates around the world. The symposium will also highlight the critical role that multiple organizations play in analyzing and disseminating mortality findings in order to strengthen overall methods and results…”

Speakers include:

Diego Bassani, Centre for Global Health Research, St. Michael’s Hospital, University of Toronto
Ties Boerma, WHO
Ed Bos, World Bank
Trevor Croft, ICF Macro
Amanda Glassman, Inter-American Development Bank
Alan Lopez, University of Queensland
Rafael Lozano, IHME and former General Director of Health Information at the Ministry of Health in Mexico
Christopher JL Murray, IHME
Kenji Shibuya, University of Tokyo

Click here for the official event announcement.

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In the wake of the recent maternal mortality estimates published in the Lancet, much of my time at my day job with the Maternal Health Task Force (MHTF) has been spent requesting and compiling reactions to the new estimates from a variety of leaders in the maternal health field.

The MHTF Blog

We tracked down responses to the new estimates from numerous maternal health organizations and professionals from a variety of disciplines including policy analysts, advocates, filmmakers, public health programmers, and researchers.  Their short blog posts provide diverse perspectives on what these new estimates really mean, the potential of the estimates to influence global health funding and policies, and recommendations for where to go from here.

Take a look at what several leading organizations and individuals had to say about the new maternal mortality estimates:

Averting Maternal Death and Disability (AMDD)

Dr. Ana Langer, EngenderHealth

Ann M. Starrs, Family Care International

Claire Bangser, Ashoka

Dr. Harshad Sanghvi, JHPIEGO

Initiative for Maternal Mortality Programme Assessment, (IMMPACT)

Jeremy Shiffman, Maxwell School of Citizenship and Public Affairs

Lisa Russell, Governess Films and MDGfive.com

Dr. Marco Gomez, Centre for Health Policy and Innovation

Meg Wirth, Maternova

I hope you enjoy reading their responses–please let me know your thoughts!

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On April 13th 2010, the New York Times published an article,  Maternal Deaths Decline Sharply Across the Globe, about the recent findings published in the Lancet that suggest a dramatic reduction in global maternal mortality. Since then, the paper has published a series of Letters to the Editor. These letters come  from leaders of organizations working on reproductive and maternal health and from health professionals working on maternal health on the ground in countries where maternal mortality continues to be a major problem.

The New York Times

A variety of opinions and sentiments are expressed in these letters that certainly add depth to the initial story published in the Times. Two themes pound through the letters: a new sense of hope that improvements in maternal health are possible and a sense of urgency that this battle has not yet been won–that now, more than ever, is the time for the maternal health community to stick together (despite squabbles among advocates over whether or not the Lancet should have published the paper when they did) and engage in concerted efforts (that include emergency obstetric care, HIV services, and expanded access to family planning) to achieve MDG5.

A careful look at these letters will stimulate a much more robust understanding of the myriad of factors contibuting to global maternal mortality—as well as the potential implications of the findings of the Lancet paper and necessary next steps towards achieving MDG5.

Some authors express cautious excitment that investments are (or might be depending on the author) paying off while simultaneously declaring that it is not yet time to celebrate; far too many women are still dying of pregnancy-related causes!  Joanne Jorissen Chiwaula, director of the African Mothers Health Initiative describes her frustration with Chris Murray (one of the authors of the Lancet paper) for downplaying the importance of emergency obstetric care services in favor of playing up the importance of HIV services, when a comprehensive approach is really what is needed. Mary Robinson, president of Realizing Rights: The Ethical Globalization Initiative, calls attention to the relationship between maternal health and discimination against women, lack of reproductive choices for women, child marriage, sexual violence, unsafe abortions and inability to own property. She emphasizes the importance of considering maternal health in the context of human rights—and also points out the need to focus on strengthening entire health systems. 

Take a look at a group of Letters to the Editor published on April 18th, and more on April 19th.

For readers comments on the initial story in the Times, click here.

And for Nicholas Kristof’s take on the new maternal mortality estimates, click here.

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