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Global, Regional, and National Levels of Maternal Mortality, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015 Publisher Pubmed



Kassebaum NJ1 ; Barber RM1 ; Dandona L1, 4 ; Hay SI1, 5 ; Larson HJ1, 7 ; Lim SS1 ; Lopez AD1, 9 ; Mokdad AH1 ; Naghavi M1 ; Pinho C1 ; Steiner C1 ; Vos T1 ; Wang H1 ; Achoki T1 Show All Authors
Authors
  1. Kassebaum NJ1
  2. Barber RM1
  3. Dandona L1, 4
  4. Hay SI1, 5
  5. Larson HJ1, 7
  6. Lim SS1
  7. Lopez AD1, 9
  8. Mokdad AH1
  9. Naghavi M1
  10. Pinho C1
  11. Steiner C1
  12. Vos T1
  13. Wang H1
  14. Achoki T1
  15. Anderson GM1
  16. Arora M1
  17. Biryukov S1
  18. Blore JD1
  19. Carter A1
  20. Casey DC1
  21. Coates MM1
  22. Coggeshall M1
  23. Dicker DJ1
  24. Dossou E1
  25. Fleming T1
  26. Fraser MS1
  27. Friedman J1
  28. Fullman N1
  29. Graetz N1
  30. Hancock J1
  31. Huynh C1
  32. Iannarone M1
  33. Kemmer L1
  34. Kulikoff XR1
  35. Kutz MJ1
  36. Liu PY1
  37. Marquez N1
  38. Misganaw A1
  39. Mooney MD1
  40. Moradilakeh M1
  41. Ng M1
  42. Nguyen G1
  43. Pain A1
  44. Shackelford KA1
  45. Silpakit N1
  46. Sligar A1
  47. Smith JM1
  48. Sorensen RJD1
  49. Vollset SE1, 140, 180
  50. Wagner JA1
  51. Wolock T1
  52. Zhao Y1, 430
  53. Zhou M1, 8
  54. Murray CJL1
  55. Ebel BE1
  56. Futran ND1
  57. Harun KM1, 188
  58. Bhutta ZA2, 3
  59. Nisar MI2
  60. Akseer N3, 32
  61. Jeemon P4, 212, 213
  62. Dandona R4
  63. Goenka S4
  64. Kumar GA4
  65. Gething PW5
  66. Bisanzio D5
  67. Deribew A5, 135
  68. Cooper C5, 124, 125
  69. Ali R5
  70. Bennett DA5
  71. Jha V5, 214
  72. Rahimi K5
  73. Kinfu Y6
  74. Murthy GVS7, 294
  75. Li Y8, 251
  76. Liu S8
  77. Wang L8
  78. Liang X8
  79. Yu S8
  80. Azzopardi P9, 72
  81. Gibney KB9, 167
  82. Meretoja A9, 275
  83. Szoeke CEI9
  84. Alam K9, 39
  85. Colquhoun SM9
  86. Weintraub RG9, 414
  87. Wijeratne T9, 416
  88. Lozano R10
  89. Camposnonato IR10, 12
  90. Campuzano JC10
  91. Gomezdantes H10
  92. Lamadridfigueroa H10
  93. Mejiarodriguez F10
  94. Montanez Hernandez JC10
  95. Montero P10
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  100. Barnighausen T12, 78, 79
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  103. Fitchett JRA12
  104. Abajobir AA13
  105. Knibbs LD13
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  107. Alam NKM13, 40
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  109. Abate KH14
  110. Gebrehiwot TT14
  111. Gebremedhin AT14, 164
  112. Abbas KM15
  113. Abdallah F16
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  121. Betsu BD19
  122. Gebremedhin M19
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  227. Colistro V111, 123
  228. Chang H112, 113
  229. Chang J114
  230. Chavan L115
  231. Chibueze CE116, 292
  232. Chisumpa VH117, 118
  233. Mapoma CC117
  234. Masiye F117
  235. Choi JJ119
  236. Chowdhury R120
  237. Christopher DJ121
  238. Cirillo M122
  239. Cooper LT126
  240. Dahiru T127
  241. Damasceno A128
  242. Danawi H129
  243. Refaat AH129, 345
  244. Neves JD130
  245. Santos JV130
  246. De Leo D131
  247. Dellavalle RP132
  248. Deribe K133, 134
  249. Hailu AD134
  250. Tefera W134
  251. Giref AZ134
  252. Jibat T134, 166
  253. Shifa GT134
  254. Des Jarlais DC136, 137
  255. Dharmaratne SD138
  256. Dubey M139
  257. Rahman MHU139
  258. Ram U139
  259. Singh A139
  260. Yadav AK139
  261. Ellingsen CL140
  262. Savic M140
  263. Skirbekk V140, 190
  264. Elyazar I141
  265. Ermakov SP142, 143
  266. Soshnikov S143
  267. Eshrati B144, 145
  268. Farzadfar F146
  269. Kasaeian A146
  270. Pishgar F146
  271. Esteghamati A146
  272. Hafezinejad N146
  273. Sheikhbahaei S146
  274. Khosravi A146, 237
  275. Malekzadeh R146
  276. Roshandel G146, 349
  277. Sepanlou SG146
  278. Rahimimovaghar V146
  279. Farid TA148
  280. Khan AR148
  281. Farinha CSES149, 150
  282. Faro A151
  283. Fernandes JC153
  284. Fischer F154
  285. Foigt N155
  286. Franca EB156
  287. Franklin RC157
  288. Furst T158, 159, 160
  289. Majeed A158
  290. Gambashidze K161
  291. Kazanjan K161
  292. Kereselidze M161
  293. Khonelidze I161
  294. Shakhnazarova M161
  295. Sturua L161
  296. Gamkrelidze A162
  297. Gebre T163
  298. Geleijnse JM166
  299. Giroud M168
  300. Gishu MD169, 170
  301. Tura AK169, 189
  302. Glaser E171
  303. Gona P172
  304. Goodridge A173
  305. Gopalani SV174
  306. Goto A175
  307. Gugnani HC176
  308. Gupta R177, 178
  309. Gupta V179
  310. Hailu AD134
  311. Norheim OF180
  312. Hamadeh RR181
  313. Hamidi S182
  314. Handal AJ183
  315. Hankey GJ184, 185, 186
  316. Harikrishnan S187
  317. Hoek HW189, 190
  318. Horino M191, 192
  319. Horita N193
  320. Hosgood HD194
  321. Hoy DG195
  322. Hu G197
  323. Huang H198
  324. Huybrechts I199, 200
  325. Iburg KM201
  326. Idrisov BT202, 203
  327. Iyer VJ204
  328. Jacobsen KH205
  329. Jahanmehr N206
  330. Jakovljevic MB207
  331. Javanbakht M208
  332. Jayatilleke AU209, 210
  333. Jee SH211
  334. Lal DK213, 294
  335. Zodpey S213, 294
  336. Jiang G215
  337. Jiang Y216
  338. Jonas JB217
  339. Kabir Z218
  340. Kamal R219
  341. Kesavachandran CN219
  342. She J220
  343. Kan H220
  344. Karch A221, 222
  345. Karletsos D223
  346. Kaul A224
  347. Kawakami N225
  348. Shibuya K225
  349. Kayibanda JF226
  350. Kazi DS227
  351. Keiyoro PN228, 229
  352. Kengne AP231, 232
  353. Wiysonge CS231, 298
  354. Sliwa K232
  355. Keren A233
  356. Khader YS234
  357. Khan EA235
  358. Khang YH236
  359. Won S236
  360. Khubchandani J238
  361. Kim YJ239
  362. Kokubo Y240
  363. Kosen S241
  364. Koul PA242
  365. Koyanagi A243
  366. Krishnaswami S244
  367. Defo BK245
  368. Bicer BK246
  369. Lam H247
  370. Lan Q248
  371. Laryea DO249
  372. Leung R250
  373. Lipshultz SE252, 253, 417
  374. Wilkinson JD252, 253, 417
  375. Simard EP254
  376. Liu Y254
  377. Phillips MR254, 333
  378. Xiao Q254
  379. Lloyd BK255, 256
  380. Lunevicius R257, 258
  381. Pope D258
  382. Ma S259, 260
  383. Abd El Razek HM261
  384. Abd El Razek MM262
  385. Marcenes W263
  386. Meaney PA264, 268
  387. Margolis DJ264
  388. Marzan MB265
  389. Masonjones AJ266
  390. Mazorodze TT267
  391. Mehari A269
  392. Mehndiratta MM270
  393. Woldeyohannes SM271
  394. Tedla BA271, 388
  395. Memish ZA272, 273
  396. Mendoza W274
  397. Meretoja TJ276, 277
  398. Mhimbira FA278
  399. Miller TR279, 280
  400. Mills EJ281
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  403. Mohammadi A284
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  411. Morawska L291
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  413. Mori R116, 292
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Source: The Lancet Published:2016


Abstract

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
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