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Lancet. 2016 Oct 8;388(10053):1775-1812. doi: 10.1016/S0140-6736(16)31470-2.

Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.

Collaborators (540)

Kassebaum NJ, Barber RM, Bhutta ZA, Dandona L, Gething PW, Hay SI, Kinfu Y, Larson HJ, Liang X, Lim SS, Lopez AD, Lozano R, Mensah GA, Mokdad AH, Naghavi M, Pinho C, Salomon JA, Steiner C, Vos T, Wang H, Abajobir AA, Abate KH, Abbas KM, Abd-Allah F, Abdallat MA, Abdulle AM, Abera SF, Aboyans V, Abubakar I, Abu-Rmeileh NM, Achoki T, Adebiyi AO, Adedeji IA, Adelekan AL, Adou AK, Afanvi KA, Agarwal A, Kiadaliri AA, Ajala ON, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam NK, Alasfoor D, Aldhahri SF, Aldridge RW, Alhabib S, Ali R, Alkerwi A, Alla F, Al-Raddadi R, Alsharif U, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Ammar W, Amrock SM, Andersen HH, Anderson GM, Antoine RM, Antonio CA, Aregay AF, Ärnlöv J, Arora M, Arsenijevic VS, Artaman A, Asayesh H, Atique S, Avokpaho EF, Awasthi A, Quintanilla BP, Azzopardi P, Bacha U, Badawi A, Bahit MC, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Basu S, Bayou TA, Bayou YT, Bazargan-Hejazi S, Beardsley J, Wang NH, Bedi, Bekele T, Bell ML, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Biadgilign S, Bikbov B, Bin Abdulhak AA, Biroscak BJ, Biryukov S, Bisanzio D, Bjertness E, Blore JD, Brainin M, Brazinova A, Breitborde NJ, Brugha TS, Butt ZA, Campos-Nonato IR, Campuzano JC, Cárdenas R, Carrero JJ, Carter A, Casey DC, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Chang HY, Chang JC, Chavan L, Chibueze CE, Chisumpa VH, Choi JJ, Chowdhury R, Christopher DJ, Ciobanu LG, Cirillo M, Coates MM, Coggeshall M, Colistro V, Colquhoun SM, Cooper C, Cooper LT, Cortinovis M, Dahiru T, Damasceno A, Danawi H, Dandona R, das Neves J, Leo D, Dellavalle RP, Deribe K, Deribew A, Des Jarlais DC, Dharmaratne SD, Dicker DJ, Ding EL, Dossou E, Dubey M, Ebel BE, Ellingsen CL, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Faraon EJ, Farid TA, Farinha CS, Faro A, Farvid MS, Farzadfar F, Fereshtehnejad SM, Fernandes JC, Fischer F, Fitchett JR, Fleming T, Foigt N, Franca EB, Franklin RC, Fraser MS, Friedman J, Fullman N, Fürst T, Futran ND, Gambashidze K, Gamkrelidze A, Gebre T, Gebrehiwot TT, Gebremedhin AT, Gebremedhin M, Gebru AA, Geleijnse JM, Gibney KB, Giref AZ, Giroud M, Gishu MD, Glaser E, Goenka S, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Goto A, Graetz N, Gugnani HC, Guo Y, Gupta R, Gupta R, Gupta V, Hafezi-Nejad N, Hailu AD, Hailu GB, Hamadeh RR, Hamidi S, Hancock J, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Harun KM, Havmoeller R, Hoek HW, Horino M, Horita N, Hosgood HD, Hoy DG, Htet AS, Hu G, Huang H, Huang JJ, Huybrechts I, Huynh C, Iannarone M, Iburg KM, Idrisov BT, Iyer VJ, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayatilleke AU, Jee SH, Jeemon P, Jha V, Jiang G, Jiang Y, Jibat T, Jonas JB, Kabir Z, Kamal R, Kan H, Karch A, Karletsos D, Kasaeian A, Kaul A, Kawakami N, Kayibanda JF, Kazanjan K, Kazi DS, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kereselidze M, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khang YH, Khonelidze I, Khosravi A, Khubchandani J, Kim YJ, Kivipelto M, Knibbs LD, Kokubo Y, Kosen S, Koul PA, Koyanagi A, Krishnaswami S, Defo BK, Bicer BK, Kudom AA, Kulikoff XR, Kulkarni C, Kumar GA, Kutz MJ, Lal DK, Lalloo R, Lam H, Lamadrid-Figueroa H, Lan Q, Larsson A, Laryea DO, Leigh J, Leung R, Li Y, Li Y, Lipshultz SE, Liu PY, Liu S, Liu Y, Lloyd BK, Lotufo PA, Lunevicius R, Ma S, Razek HM, Razek MM, Majdan M, Majeed A, Malekzadeh R, Mapoma CC, Marcenes W, Margolis DJ, Marquez N, Masiye F, Marzan MB, Mason-Jones AJ, Mazorodze TT, Meaney PA, Mehari A, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen AB, Melaku YA, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mhimbira FA, Miller TR, Mills EJ, Mirarefin M, Misganaw A, Ibrahim NM, Mohammad KA, Mohammadi A, Mohammed S, Mola GL, Monasta L, de la Cruz Monis J, Hernandez JC, Montero P, Montico M, Mooney MD, Moore AR, Moradi-Lakeh M, Morawska L, Mori R, Mueller UO, Murthy GV, Murthy S, Nachega JB, Naheed A, Naldi L, Nand D, Nangia V, Nash D, Neupane S, Newton JN, Ng M, Ngalesoni FN, Nguhiu P, Nguyen G, Nguyen QL, Nisar MI, Nomura M, Norheim OF, Norman RE, Nyakarahuka L, Obermeyer CM, Ogbo FA, Oh IH, Ojelabi FA, Olivares PR, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ota E, Oyekale AS, Pa M, Pain A, Papantoniou N, Park EK, Park HY, Caicedo AJ, Patten SB, Paul VK, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Pillay JD, Pishgar F, Polinder S, Pope D, Pourmalek F, Qorbani M, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MH, Rahman SU, Rai RK, Ram U, Ranabhat CL, Rangaswamy T, Rao PV, Refaat AH, Remuzzi G, Resnikoff S, Rojas-Rueda D, Ronfani L, Roshandel G, Roy A, Ruhago GM, Sagar R, Saleh MM, Sanabria JR, Sanchez-Niño MD, Santos IS, Santos JV, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Saylan MI, Schneider IJ, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Setegn T, Shackelford KA, Shaikh MA, Shakh-Nazarova M, Sharma R, She J, Sheikhbahaei S, Shen J, Shibuya K, Shin MJ, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silpakit N, Silva DA, Silveira DG, Silverberg JI, Simard EP, Sindi S, Singh A, Singh JA, Singh OP, Singh PK, Singh V, Skirbekk V, Sligar A, Sliwa K, Smith JM, Soneji S, Sorensen RJ, Soriano JB, Soshnikov S, Sposato LA, Sreeramareddy CT, Stathopoulou V, Stroumpoulis K, Sturua L, Sunguya BF, Swaminathan S, Sykes BL, Szoeke CE, Tabarés-Seisdedos R, Tabb KM, Talongwa RT, Tavakkoli M, Taye B, Tedla BA, Tefera WM, Tekle T, Shifa GT, Terkawi AS, Tesfay FH, Tessema GA, Thomson AJ, Thorne-Lyman AL, Tobe-Gai R, Topor-Madry R, Towbin JA, Tran BX, Dimbuene ZT, Tura AK, Tyrovolas S, Ukwaja KN, Uthman OA, Vasankari T, Venketasubramanian N, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Wagner JA, Wang L, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Wijeratne T, Wilkinson JD, Wiysonge CS, Woldeyohannes SM, Wolfe CD, Wolock T, Won S, Wubshet M, Xiao Q, Xu G, Yadav AK, Yakob B, Yalew AZ, Yano Y, Yebyo HG, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Yu S, Zaidi Z, Zaki ME, Zeeb H, Zhao Y, Zhao Y, Zhou M, Zodpey S, Zuhlke LJ, Murray CJ.

Erratum in

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.

PMID:
27733286
PMCID:
PMC5224694
DOI:
10.1016/S0140-6736(16)31470-2
[Indexed for MEDLINE]
Free PMC Article

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