Researchers say maternal mortality has dropped significantly in developing countries thanks to concerted efforts by nations to drive down the number of mothers who die of pregnancy-related complications. At the same time, a new report says maternal mortality has risen in some developed countries.
Between 1980 and 2008, the number of women dying during or soon after childbirth fell by more 35 percent worldwide, according to a study carried out by researchers at the University of Washington in Seattle.
In a survey of 181 nations, researchers say the number of deaths dropped from roughly 500,000 to about 343,000 per year during a nearly 30 year period, falling by about 1.4 percent each year.
Christopher Murray of the University of Washington's Institute for Health Metrics and Evaluation led the study.
He credits increased education of women in developing countries, an increased number of whom are now giving birth in hospitals.
"A second factor has been the continued decline all over the world of fertility rates," Murray added. "And fertility rates are strongly associated with maternal mortality. And that, combined with rising levels of income, are the key factors that are bringing maternal mortality down."
Using vital registration information, census data, surveys and autopsy reports to determine the maternal death rate, researchers found that maternal mortality dropped from 422 per 100,000 births nearly 30 years ago to 251 in 2008.
The nations making the biggest strides included Egypt, Ecuador and Bolivia. Researchers say China also had a steep drop in maternal mortality, from 165 to 40 deaths per 100,000.
Italy had the lowest maternal mortality rate in 2008. Researchers found that only four in 100,000 women there died of pregnancy-related complications.
But in some countries in sub-Saharan Africa, maternal mortality rate rose, including in Zimbabwe - the worst performing nation - which posted a 5.5 percent annual increase since 1990.
Almost 80 percent of all maternal deaths were concentrated in 21 countries in 2008; nearly half were in only six countries - India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic Republic of the Congo.
HIV played an unexpected role, according to Christopher Murray, who says the sexually transmitted disease has slowed efforts to reduce the maternal mortality rate in some African countries.
Dr. Murray says the AIDS virus was responsible for more than 64,000 of the 343,000 maternal deaths in 2008.
"And I think this is very important for future policy on maternal health because we haven't made a strong connection between HIV care and maternal health before," added Murray. "And that's clearly what needs to happen in those regions."
Maternal mortality rates increased during the near 30 year period in some Western countries, notably in the United States, which saw a nearly 42 percent increase from 12 to 17 deaths per 100,000 women since 1990. Dr. Murray says the increase is likely due to better record keeping.
He says developing countries are on their way toward meeting the United Nations' Millennium Development goal of reducing maternal mortality by 75 percent worldwide by 2015.
The University of Washington's Christopher Murray says the next step is to study why some countries were so successful in driving down their maternal mortality rates and apply those lessons in other nations.
The study on global maternal mortality rates is published in the medical journal The Lancet.