Hunger and malnutrition were observed to increase the incidence and fatality rate of the conditions that contribute to nearly 80 percent of maternal deaths.
In this regard, millennium development goal 5 has two targets:
- To reduce the maternal mortality ratio by 75 percent
- To achieve universal access to reproductive health
Improving maternal health is critical to saving the lives of hundreds of thousands of women who die due to complication from pregnancy and childbirth each year. Over 90 percent of these deaths could be prevented if women in developing regions had access to sufficient diets, basic literacy and health services, and safe water and sanitation facilities during pregnancy and childbirth.
Some of the achievements of MDG 5 include:
- A 45 percent reduction in the maternity mortality ratio worldwide since 1990, though most of the reduction occurred since 2000
- A 64 percent reduction in maternal mortality ratio in Southern Asia between 1990 and 2013, and 49 percent in sub-Saharan Africa
- A 12 percent increase in the number of births assisted by skilled health personnel globally in 2014 compared to 1990 – 59 percent to 71 percent.
- An increase in the proportion of pregnant women receiving four or more antenatal visits in North Africa from 50 percent in 1990 to 89 percent in 2014.
- Increase in contraceptive prevalence among women 15 – 49 years old – whether married or in some other union – from 55 to 64 percent between 1990 and 2015.
Target #1: Maternal survival
Maternal death has dropped significantly since the adoption of the MDGs. The universal maternal mortality ratio has reduced by 45 percent between 1990 and 2013, from 380 to 210 maternal deaths per 100,000 live births.
Despite the progress, every day lots of women die during pregnancy or from complications arising from childbirth. The maternal mortality rate in developing regions is around 14 percent higher than in developed nations. Universally, there were an estimated 289,000 maternal deaths in 2013, which is equivalent to around 800 women dying daily. The highest rate of maternal deaths is in sub-Saharan Africa and Southern Asia, which collectively accounted for 86 percent of global maternal deaths.
Most of these deaths are preventable, with hemorrhage accounting for over 27 percent of maternal deaths in developing regions and about 16 percent in the developed regions. Other complications leading to death include high blood pressure during pregnancy, infections, unsafe abortion, and complications from delivery.
Proven health-care interventions can help manage or prevent these complications, including skilled care during childbirth, antenatal care in pregnancy, and care and support in the weeks following childbirth.
Target #2: Universal Access to reproductive health
The WHO recommends four or more antenatal care visits during pregnancy to ensure the wellbeing of mothers and newborns. During these visits, women should be given nutritional advice, alerted to warning signs indicating possible problems during their term, and given support when planning a safe delivery.
Progress has been slow since 1990, with an average of 52 percent of pregnant women in developing regions receiving the recommended number of antenatal care visits in 2014, a 17 percent increase in 25 years. Coverage levels in sub-Saharan Africa have remained still for the past two decades, with slight improvement in the number of women receiving the recommended care: 47 to 49 percent.
Use of contraceptives
Universally, the number of women aged 15 – 49 in marriage or a union, who were using contraceptives (as a way to reduce the incidence of unintended pregnancies, maternal deaths, and unsafe abortions) has increased from 55 to 64 percent between 1990 and 2015. The proportion in sub-Saharan Africa has more than doubled, from 13 to 28 percent, while that in Southern Asia increased from 39 to 59 percent in the same 25 years.
Nine in every 10 contraceptive users were using effective methods, including condoms, injectables, intrauterine devices, female and male sterilisation, oral hormonal pills, or an implant.
Adolescent childbearing is not only harmful to the health of both the girls and child they bear, but also reflects the broader forms of social and economic marginalisation of girls. Certain measures have been taken to delay childbearing and prevent unintended pregnancies among this vulnerable age group, including increasing their opportunities for education and eventual paid employment. As a result, the birth rate among adolescent girls aged 15 – 19 has reduced from 59 births per 1,000 girls to 51 births between 1990 and 2015.
One of the most fundamental ways to reduce maternal morbidity and mortality is ensuring that every birth occurs with the help of skilled health personnel – midwife, nurse, or doctor. Progress in increasing the proportion of births delivered with skilled attendance has been modest over the MDG time frame, which is an indication of the lack of universal access to care.
Significant progress has been made in reducing maternal deaths and increasing global access to reproductive health, though the targets were not achieved. Improvements can be made by addressing the large inequities in maternal health, and strengthening individual country capacity to tackle the problems.