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Lancet. 2016 Oct 29;388(10056):2164-2175. doi: 10.1016/S0140-6736(16)31533-1. Epub 2016 Sep 16.

Diversity and divergence: the dynamic burden of poor maternal health.

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Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Institute of Education for Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK. Electronic address:
Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Umeå Centre for Global Health Research, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden; Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
Reproductive Health Commodity Security Branch, United Nations Population Fund, New York, NY, USA.
Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
South African Medical Research Council Maternal and Infant Health Care Strategies Unit, University of Pretoria, Pretoria, South Africa.
Guttmacher Institute, New York, NY, USA.


Maternal health is a big issue and is central to sustainable development. Each year, about 210 million women become pregnant and about 140 million newborn babies are delivered-the sheer scale of maternal health alone makes maternal well being and survival vital concerns. In this Series paper, we adopt primarily a numerical lens to illuminate patterns and trends in outcomes, but recognise that understanding of poor maternal health also warrants other perspectives, such as human rights. Our use of the best available evidence highlights the dynamic burden of maternal health problems. Increased diversity in the magnitude and causes of maternal mortality and morbidity between and within populations presents a major challenge to policies and programmes aiming to match varying needs with diverse types of care across different settings. This diversity, in turn, contributes to a widening gap or differences in levels of maternal mortality, seen most acutely in vulnerable populations, predominantly in sub-Saharan Africa. Strong political and technical commitment to improve equity-sensitive information systems is required to monitor the gap in maternal mortality, and robust research is needed to elucidate major interactions between the broad range of health problems. Diversity and divergence are defining characteristics of poor maternal health in the 21st century. Progress on this issue will be an ultimate judge of sustainable development.

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