Millennium Development Goal Five

Improve maternal health

Target 6: Between 1990 and 2015, reduce the maternal mortality ratio by three quarters.

Progress

Although most maternal deaths are preventable, MDG 5 is proving hard to reach – despite maternal health being high on the international agenda for more than two decades.

More than half a million women continue to die each year from complications of pregnancy and childbirth, almost all in sub-Saharan Africa and Asia. Some progress has been made in reducing maternal deaths, although not in the countries where giving birth is most risky. In some parts of Africa (for example, Malawi and Zimbabwe) maternal deaths are increasing. This is attributable to high HIV prevalence, conflict, and deteriorating health systems.

A small number of countries, largely in Asia, have made dramatic improvements – illustrating that with the right policies, strategies and conditions in place rapid progress is possible.

Key messages

Almost all maternal deaths could be averted with access to professional care during pregnancy and childbirth and the few weeks after, as well as access to emergency obstetric care in the event of complications.
Experience from Thailand, Bangladesh and Sri Lanka shows that maternal mortality can be reduced in low-income settings – by increasing access to skilled attendants, emergency obstetric care and family planning services.
There are significant differences in access to maternal health services, e.g. in Ethiopia, the rich are 28 times more likely than the poor to have a skilled attendant at delivery.
Maternal deaths are just the tip of the iceberg – which is why MDG 5 also aims to improve maternal health. For every maternal death, there are at least 20 additional women who suffer serious pregnancy-related complications that can cause lifelong disabilities.
The health and survival chances of a newborn baby are largely determined by the mother’s health and nutrition and prenatal and antenatal care that she receives.
To make the best possible progress in reducing maternal deaths and disability, there must be the political will to act. Improving the status and rights of women and increasing all women’s access to essential maternal health services must be made a priority concern.

Facts and figures

Every year more than half a million women die due to complications of pregnancy and childbirth – 99% in developing countries. A further nine million more women suffer complications that can result in life long pain, disability and socio-economic exclusion.
The chances of suffering a maternal death over a woman’s lifetime is one in 6 in Sierra Leone compared to one in 3,800 in the UK – a 600 fold difference.
Millions of women are left without care at the birth of their babies - nearly one in four women in developing countries is alone, or with only a relative or neighbour to assist them at childbirth – this has not changed since the early 1990s.
Antenatal care is a core component of maternal health services. Since 1990, every region has made progress in this respect. Even in sub-Saharan Africa, more than two thirds of women receive antenatal care at least one time during pregnancy.
Maternal death is the leading cause of death for girls aged 15-19 in the developing world - they are twice as likely to die in childbirth as women in their twenties. High adolescent birth rates continue, despite reductions in total fertility in many regions.
Preventing unplanned pregnancies alone could avert at least one quarter of maternal deaths each year, including the 68,000 that result from unsafe abortion. 137 million women who have expressed a desire to space or limit their family size are not using any form of contraception – a further 64 million rely on less effective traditional methods.
US$1 million invested in family planning could avert 360,000 unwanted pregnancies, prevent 150,000 induced abortions and save the lives of 800 mothers and 11,000 infants.

Challenges and solutions

Sexual and reproductive health and rights, defined in the International Conference on Population and Development’s Programme of Action, are critical to meeting all the MDGs, particularly those on maternal & child health and HIV prevention. Universal access to sexual and reproductive health, including HIV prevention and, where legal, safe abortion services, would significantly improve maternal health and reduce the number of unwanted and unplanned pregnancies.

The world’s poorest countries do not have health systems capable of providing the required maternal health services. Key elements must be strengthened including increasing the numbers of health providers with midwifery skills and providing obstetric care for women who experience complications. Non-health interventions also need to be improved including, water and sanitation, infrastructure, power, transport and communications.

Underlying high levels of maternal death and disability is a reflection of the failure to assure women’s rights. Women’s low status and heavy physical workloads, lack of power, poor access to information and care, restricted mobility, early age of marriage and the low political priority and resources given to their health all contribute to high mortality. In many settings, overcoming this means challenging the cultural and political norms and legal frameworks that limit women’s ability to make informed choices about, and take appropriate actions to ensure, healthy sexual and reproductive lives.

Assessing progress towards MDG 5 is hampered by limited data availability and the challenges inherent in measuring maternal mortality and morbidity. This is particularly true in countries where the registration of birth and deaths is incomplete and cause of death is not ascertained.

What the UK government is doing to help

DFID’s Strategies and Position Papers

In April 2007, we published the second progress report against our maternal health strategy – Reducing Maternal Deaths: Evidence and Action. The strategy is supported by our 2004 position paper on Sexual and Reproductive Health and Rights and our 2005 guidance note How to reduce maternal deaths: rights and responsibilities which aims to help DFID staff bring a rights and equity perspective to their work.

More attention to, and expenditure on, maternal health

Many of DFID’s Country Assistance Plans commit to addressing maternal mortality and improving sexual and reproductive health. Bilateral spending that specifically addresses maternal and reproductive health was £32.3 million in 2005/2006 (excluding Poverty Reduction Budget Support).
DFID also makes significant contributions to the maternal health programmes of the EC, the World Bank and international and national civil society groups. We also fund and collaborate with the UN health and development agencies such as the WHO, UNFPA and UNICEF.
In February 2006, DFID committed £3 million to the Safe Abortion Action Fund developed by the International Planned Parenthood Federation which aims to reduce the 13% of maternal deaths that result from unsafe abortion. We have also encouraged other donors to contribute.

Ensuring Harmonised and Co-ordinated Working

DFID is an active member of the global Partnership for Maternal, Newborn and Child Health, which promotes coordination and harmonisation of policies. We are also pushing for a clearer division of labour between WHO, UNICEF and UNFPA in maternal, newborn and child health and encouraging the UN to take leadership in this field as have they have done for AIDS.
DFID is a key partner in the Norwegian government’s drive to achieve MDGs 4 and 5 – and specifically in helping NORAD to draw up a Global Business Plan for tackling maternal and child deaths.

Developing New Knowledge

We support research programme consortia on maternal, neonatal and child health and sexual and reproductive health and rights. We also support the Initiative for Maternal Mortality Programme Assessment (IMMPACT) with the Gates Foundation, USAID and the EC.
We also support the work of the Health Metrics Network to help countries to provide better data to track their progress towards MDG5. This includes supporting progress towards better registration of births and deaths, improved estimation of maternal death rates from surveys and censuses, and supporting the development of indicators to better measure improvements in reproductive health.