One pregnant woman or newborn dies every 11 seconds from preventable causes despite major progress made in healthcare
Since 2000, child deaths have reduced by nearly half and maternal deaths by over one-third, mostly due to improved access to affordable, quality health services
Every 11 seconds, a pregnant woman or newborn dies in some part of the world - totaling an estimated 2.8 million annually - mostly of preventable causes. This is despite the fact that more women and their children are surviving today than ever before, according to new estimates on child and maternal mortality by the United Nations Maternal Mortality Estimation InterAgency Group (UN MMEIG).
Since 2000, child deaths have reduced by nearly half and maternal deaths by over one-third, mostly due to improved access to affordable, quality health services. The global estimates for the year 2017 indicate that there were 295,000 maternal deaths; 35% lower than in 2000 when there were an estimated 451,000 maternal deaths.
The global maternal mortality ratio (MMR) in 2017 is estimated at 211 maternal deaths per 100,000 live births, representing a 38% reduction since 2000, when it was estimated at 342. Maternal mortality ratio is the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time period.
According to the analysis, the average annual rate of reduction in global MMR during the 2000–2017 period was 2.9%. This implies that on average, the global MMR declined by 2.9% every year between 2000 and 2017.
“In countries that provide everyone with safe, affordable, high-quality health services, women and babies survive and thrive. This is the power of universal health coverage,” says Dr. Tedros Adhanom Ghebreyesus, Director-General of WHO.
However, despite progress, maternal mortality is still unacceptably high. Of the 295,000 women who died in in 2017, the vast majority of these deaths or 94% occurred in low-resource settings, and most could have been prevented. The high number of maternal deaths in some areas of the world reflects inequalities in access to quality health services and highlights the gap between rich and poor. The MMR in low-income countries in 2017 is 462 per 100,000 live births versus 11 per 100,000 live births in high-income countries
“Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy, and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care. The primary complications that account for nearly 75% of all maternal deaths are severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy, and unsafe abortion," says the report.
The UN MMEIG comprises the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), the World Bank Group and the United Nations Population Division (UNPD) of the Department of Economic and Social Affairs.
Skilled care before, during, and after childbirth can save the lives of women and newborns, says the team. “Around the world, birth is a joyous occasion. Yet, every 11 seconds, a birth is a family tragedy,” A skilled pair of hands to help mothers and newborns around the time of birth, along with clean water, adequate nutrition, basic medicines, and vaccines, can make the difference between life and death. We must do all it takes to invest in universal health coverage to save these precious lives,” says Henrietta Fore, UNICEF Executive Director.
The estimates show vast inequalities worldwide, with women in sub-Saharan Africa facing a substantially higher risk of death than in all other regions. Women in sub-Saharan Africa face a 1 in 37-lifetime risk of dying during pregnancy or childbirth. By comparison, the lifetime risk for a woman in Europe is 1 in 6500.
Sub-Saharan Africa and Southern Asia accounted for approximately 86% (254,000) of the estimated global maternal deaths in 2017. While sub-Saharan Africa alone accounted for roughly 66% (196,000), Southern Asia accounted for nearly 20% (58000). South-Eastern Asia, in addition, accounted for over 5% of global maternal deaths (16000).
“Three countries are estimated to have had extremely high MMR in 2017 (defined as over 1000 maternal deaths per 100 000 live births): South Sudan (1150), Chad (1140) and Sierra Leone (1120),” says the report.
According to the researchers, the Sustainable Development Goals (SDGs) include a direct emphasis on reducing maternal mortality while also highlighting the importance of moving beyond survival. Despite the ambition to end preventable maternal deaths by 2030, the world will fall short of this target by more than one million lives with the current pace of progress, warn the researchers. The global target for ending preventable maternal mortality is to reduce global maternal mortality ratio to less than 70 per 100 000 live births by 2030.
One child or young adolescent died every 5 seconds
Despite progress over the past two decades, in 2018 alone, an estimated 6.2 million children and young adolescents under age 15 died, mostly from preventable causes.
The total number of deaths among children and young adolescents under 15 years of age dropped by 56% from 14.2 million in 1990 to 6.2 million in 2018. Yet, says the report, one child or young adolescent died every five seconds in 2018. The researchers say for many children, where they are born and live determines their access to quality, affordable healthcare. Accordingly, too many newborns and children continue to die from easily preventable and treatable causes because countries have failed to ensure their basic right to survival and health.
“Despite the progress, the unfinished business of ending preventable child deaths looms large. If current trends continue without acceleration, some 52 million children under five years of age will die from 2019 to 2030. About half of them will be newborns. Another 10 million children aged 5-14 years will die. The total number of 62 million deaths of children under age 15 is roughly equivalent to the current population of Italy,” says the report.
Children face the highest risk of dying in the first month, especially if they are born too soon or too small, have complications during birth, congenital defects, or contract infections. About a third of these deaths occur within the first day and nearly three quarters in the first week alone.
Globally, 85% of deaths among children and young adolescents in 2018 occurred in the first five years of life, accounting for 5.3 million deaths, of which 2.5 million (47%) happened in the first month of life - which is about 7,000 every day.
The first 28 days of life – the neonatal period – are the most vulnerable time for a child’s survival. Children face the highest risk of dying in their first month of life. In 2018, the neonatal mortality rate was estimated at 18 deaths per 1,000 live births globally.
“Newborns account for 2.5 million of these (6.2 million) deaths, children aged 1-11 months for 1.5 million, children aged 1-4 years for 1.3 million, children aged 5-9 years for 560,000 and young adolescents aged 10-14 years for 360,000,” says the report.
It adds, “Based on a recent systematic review, about a third of all neonatal deaths tend to occur on the day of birth and close to three quarters die in the first week of life. These findings suggest that focusing on the critical periods, before and immediately following birth, is essential to saving more lives.”
Children continue to face widespread regional disparities in their chances of survival. SubSaharan Africa remains the region with the highest under-five mortality rate in the world - 78 deaths per 1,000 live births in 2018. This translates to 1 in 13 children dying before his or her fifth birthday, which is 16 times higher than the average ratio of 1 in 199 in high-income countries.
“In 2018, over half (3.3 million) of all children under age 15 died in sub-Saharan Africa, followed by Central and Southern Asia with 28% (1.8 million). The regions of Australia and New Zealand, Eastern and South-Eastern Asia, Northern Africa and Western Asia, Europe and Northern America, Latin America and the Caribbean and Oceania (excluding Australia and New Zealand) account for the remaining 19% or 1.2 million deaths of children under 15 years of age,” the findings state.
According to the researchers, accelerating the reduction in child mortality is possible by expanding high-impact preventative and curative interventions that target the main causes of child deaths and the most vulnerable population.