Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013

Nicholas Kassebaum, Amelia Bertozzi-Villa, Megan Coggeshall, Katya Shackelford, Caitlyn Steiner, Kyle Heuton, Diego Gonzalez-Medina, Ryan Barber, Chantal Huynh, Daniel Dicker, Tara Templin, Timothy Wolock, Ayse Ozgoren, Foad Abd-Allah, Semaw Abera, Ibrahim Abubakar, Tom Achoki, Ademola Adelekan, Zanfina Ademi, Arsene AdouJose Adsuar, Emilie Agardh, Dickens Akena, Deena Alasfoor, Zewdie Alemu, Rafael Alfonso-Cristancho, Samia Alhabib, Raghib Ali, Mazin Al Kahbouri, F Alla, Peter Allen, Mohammad AlMazroa, Ubai Alsharif, Elena Alvarez, Nelson Alvis-Guzman, Adansi Amankwaa, Azmeraw Amare, Hassan Amini, Walid Ammar, Carl Antonio, Palwasha Anwari, Johan Arnlov, Valentina Arsenijevic, Ali Artaman, Majed Asad, Rana Asghar, Reza Assadi, Lydia Atkins, Alaa Badawi, Kalpana Balakrishnan, Arin Basu, Sanjay Basu, Justin Beardsley, Neeraj Bedi, Tolesa Bekele, Michelle Bell, Eduardo Bernabe, Tariku Beyene, Zulfiqar Bhutta, Aref Abdulhak, Jed Blore, Berrak Basara, Dipan Bose, Nicholas Breitborde, Rosario Cardenas, Carlos Castaneda-Orjuela, Ruben Castro, Ferran Catala-Lopez, Alanur Cavlin, Jungchen Chang, Xuan Che, Costas Christophi, Sumeet Chugh, Massimo Cirillo, Samantha Colquhoun, Leslie Cooper, Cyrus Cooper, Iuri Da Costa Leite, Lalit Dandona, Rakhi Dandona, Adrian Davis, Anand Dayama, Louisa Degenhardt, Emerito Faraon, Farshad Farzadfar, Manuela Felicio, Seyed Fereshtehnejad, Graca De Lima, Mohammad Forouzanfar, Elisabeth Franca, Lynne Gaffikin, Ketevan Gambashidze, Fortune Gankpe, Ana Garcia, Johanna Geleijnse, Katherine Gibney, Maurice Giroud, Elizabeth Glaser, Ketevan Goginashvili, Philimon Gona, Dinorah Gonzalez-Castell, Atsushi Goto, Hebe Gouda, Harish Gugnani, Rahul Gupta, Raj Gupta, Nima Hafezi-Nejad, Randah Hamadeh, Mouhanad Hammami, Graeme Hankey, Hilda Harb, Rasmus Havmoeller, Simon Hay, Ileana Pi, Hans Hoek, H Hosgood III, Damian Hoy, Abdullatif Husseini, Bulat Idrisov, Kaire Innos, Manami Inoue, Kathryn Jacobsen, Eiman Jahangir, Sunha Jee, Paul Jensen, Vivekanand Jha, Guohong Jiang, Jost Jonas, Knud Juel, Edmond Kabagambe, Haidong Kan, Nadim Karam, Andre Karch, Corine Karema, Anil Kaul, Norito Kawakami, Konstantin Kazanjan, Dhruv Kazi, Andrew Kemp, Andre Kengne, Maia Kereselidze, Yousef Khader, Shams Khalifa, Ejaz Khan, Young-Ho Khang, Luke Knibbs, Yoshihiro Kokubo, Soewarta Kosen, Barthelemy Defo, Chanda Kulkarni, Veena Kulkarni, Gautam Kumar, Kaushalendra Kumar, Ravi Kumar, Gene Kwan, Taavi Lai, Ratilal Lalloo, Hilton Lam, Lansingh Van, Anders Larsson, Jongtae Lee, James Leigh, Mall Leinsalu, Ricky Leung, Xiaohong Li, Yichong Li, Yongmei Li, Juan Liang, Xiaofeng Liang, Stephen Lim, Hsien-Ho Lin, Steven Lipshultz, Shiwei Liu, Yang Liu, Belinda Lloyd, Stephanie London, Paulo Lotufo, Jixiang Ma, Stefan Ma, Vasco Machado, Nana Mainoo, Marek Majdan, Christopher Mapoma, Wagner Marcenes, Melvin Marzan, Amanda Mason-Jones, Man Mehndiratta, Fabiola Mejia-Rodriguez, Z Memish, Walter Mendoza, Ted Miller, Edward Mills, Ali Mokdad, Glen Mola, Lorenzo Monasta, Jonathan De La Cruz Monis, Julio Hernandez, Ami Moore, Mazier Moradi-Lakeh, Rintaro Mori, Ulrich Mueller, Mitsuru Mukaigawara, Aliya Naheed, Kovin Naidoo, Devina Nand, Vinay Nangia, Denis Nash, Chakib Nejjari, Robert Nelson, Sudan Neupane, Charles Newton, Marie Ng, Mark Nieuwenhuijsen, Muhammad Nisar, Sandra Nolte, Ole Norheim, Luke Nyakarahuka, Inhwan Oh, Takayoshi Ohkubo, Bolajoko Olusanya, Saad Omer, John Opio, Orish Orisakwe, Jeyaraj Pandian, Christina Papachristou, Jaehyun Park, Angel Caicedo, Scott Patten, Vinod Paul, Boris Pavlin, Neil Pearce, David Pereira, Konrad Pesudovs, Max Petzold, Dan Poenaru, Guilherme Polanczyk, Suzanne Polinder, Dan Pope, Farshad Pourmalek, Dima Qato, Duane Quistberg, Anwar Rafay, Kazem Rahimi, Vafa Rahimi-Movaghar, Sajjad Rahman, Murugesan Raju, Saleem Rana, Amany Refaat, Luca Ronfani, Nobhojit Roy, Tania Pimienta, Mohammad Sahraian, Joshua Salomon, Uchechukwu Sampson, Itamar Santos, Monika Sawhney, Felix Sayinzoga, Ione Schneider, Austin Schumacher, David Schwebel, Soraya Seedat, Sadaf Sepanlou, Edson Servan-Mori, Marina Shakh-Nazarova, Sara Sheikhbahaei, Kenji Shibuya, Hwashin Shin, Ivy Shiue, Inga Sigfusdottir, Donald Silberberg, Andrea Silva, Jasvinder Singh, Vegard Skirbekk, Karen Sliwa, Sergey Soshnikov, Luciano Sposato, Chandrashekhar Sreeramareddy, Konstantinos Stroumpoulis, Lela Sturua, Bryan Sykes, Karen Tabb, Robert Talongwa, Feng Tan, Carolina Teixeira, Eric Tenkorang, Abdullah Terkawi, Andrew Thorne-Lyman, David Tirschwell, Jeffrey Towbin, Bach Tran, Miltiadis Tsilimbaris, Uche Uchendu, Kingsley Ukwaja, Eduardo Undurraga, Selen Uzun, Andrew Vallely, Coen Van Gool, Tommi Vasankari, Monica Vavilala, N Venketasubramanian, Salvador Villalpando, Francesco Violante, Vasiliy Vlassov, Theo Vos, Stephen Waller, Haidong Wang, Linhong Wang, Sharon Wang, Yanping Wang, Scott Weichenthal, Elisabete Weiderpass, Robert Weintraub, Ronny Westerman, James Wilkinson, Solomon Woldeyohannes, John Wong, Muluemebet Wordofa, Gelin Xu, Claire Yang, Yuichiro Yano, Gokalp Yentur, Paul Yip, Naohiro Yonemoto, Seokjun Yoon, Mustafa Younis, Chuanhua Yu, Kimyun Jin, Maysaa El Sayed Zaki, Yong Zhao, Yingfeng Zheng, Maigeng Zhou, Jun Zhu, Xiaonong Zou, Alan Lopez, Mohsen Naghavi, Christopher Murray, Rafael Lozano, Diego De Leo, Borja Del Pozo-Cruz, Kebede Deribe, Gabrielle deVeber, Samath Dharmaratne, Ugur Dilmen, Eric Ding, Rob Dorrington, T Driscoll, Sergei Ermakov, Alireza Esteghamati

    Research output: Contribution to journalArticle

    751 Citations (Scopus)

    Abstract

    Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine diff erent causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261 017-327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483-407 574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. Funding Bill & Melinda Gates Foundation.

    Original languageEnglish
    Pages (from-to)980-1004
    Number of pages25
    JournalLancet
    Volume384
    Issue number9947
    DOIs
    Publication statusPublished - 2014

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  • Cite this

    Kassebaum, N., Bertozzi-Villa, A., Coggeshall, M., Shackelford, K., Steiner, C., Heuton, K., Gonzalez-Medina, D., Barber, R., Huynh, C., Dicker, D., Templin, T., Wolock, T., Ozgoren, A., Abd-Allah, F., Abera, S., Abubakar, I., Achoki, T., Adelekan, A., Ademi, Z., ... Esteghamati, A. (2014). Global, regional, and national levels and causes of maternal mortality during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9947), 980-1004. https://doi.org/10.1016/S0140-6736(14)60696-6