Maternal and Child Death Rates Are at a Concerning Plateau

Data shared in reports by The United Nations Maternal Mortality Estimation Inter-Agency Group (MMEIG) and Interagency Group for Child Mortality Estimation (IGME) show that in the first several years of the Sustainable Development Goals (SDGs) project, the maternal mortality rate barely declined and the child mortality rate declined only slightly.²

Considered one of the biggest public health achievements of the aughts, the global rate for maternal mortalities previously decreased by 33 percent between 2000 and 2015 (vii). The MMEIG report, which was published in February 2023, estimates the global MMR in 2020 being at 223 maternal deaths per 100,000 live births. In 2015 the estimated MMR was just four deaths higher at 227. If this slow rate of decline continues, the group estimates a 2030 rate of 222 maternal deaths per 100,000 live births, putting the MMR at more than three times the original goal (xiv).¹

Globally, the under-five mortality rate (U5MR) fell from 43 to 38 deaths per 1,000 live births in 2021 (4).² While fewer deaths is still an accomplishment, the averaging of the global number obscures the huge difference in chances of survival for children based on their location. For example, in sub-Saharan Africa, the rate was 74 deaths per 1,000 live births. In low-income countries, the 2021 under-five mortality rate was 67 deaths per 1,000 live births, versus just 5 deaths per 1,000 live births in high-income countries (4).² The 2030 SDG for an under-five mortality rate (U5MR) is 25 or fewer deaths per 1,000 live births (6).²

The Sustainable Development Goals were launched by the United Nations (UN) in January 2016, meant to be in place for 15 years until December 2030. The SDGs are meant to “transform the world,” by issuing a “call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health justice and prosperity.” Maternal and child mortality are the first and second targets of Goal 3 “to ensure healthy lives and promote well-being for all at all ages.”

Target 1 is focused on maternal mortality and is specifically to reduce the global maternal mortality rate (MMR) to fewer than 70 maternal deaths per 100,000 live births by 2030. Target 2 is neonatal and child mortality, focused on ending preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births.³

According to the World Health Organization, which is the health authority arm within the United Nations, the SDGs were made to offer a comprehensive vision for sustainable development that:⁴

• Is global, rather than limited to “developing” countries as was the case with the Millennium Development Goals previously set by the UN from 2000-2015
• Is based on values such as equity and respect for human rights
• Relies on approaches such as sustainable financing, scientific research and innovation, and monitoring and evaluation
• Requires a new way of working, involving intersectoral action by multiple stakeholders;
• Aims to strengthen health systems towards universal health coverage

While Goal 3 is specifically focused on global gains in health, many of the other goals and targets intersect with those of Goal 3 to encourage a holistic approach to health and well-being. Akin to other public health and health equity movements, the other goals target social determinants of health such as poverty, climate action, sustainability, access to clean water and quality education.

Maternal death, or obstetric death, is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes (7).”¹

The MMEIG identifies four primary causes of maternal mortality (45):¹

• Health system failures: specifically those that translate to delay in seeking care and receiving care after reaching the health-care facility, poor quality of care, shortages of essential medical supplies, and poor accountability of health systems.

• Social determinants: Factors including income, access to education, race and ethnicity, that put some subpopulations at greater risk.

• Harmful gender norms, biases and inequalities: Intentional or unintentional discrimination that results in a low prioritization of the rights of women and girls, including their right to safe, quality and affordable sexual and reproductive health services.

• External factors contributing to instability and health system fragility: Emergent humanitarian settings, and conflict, post-conflict and disaster situations. The report identifies the climate crisis as “the most devastating global health threat of the 21st century” citing effects like exposure to extreme heat, extreme weather events and air pollution reduced access to services due to infrastructure destruction, income loss, poverty and malnutrition (45-46).

The MMEIG report encourages renewed efforts to work collaboratively across agencies to tackle these areas of weakness which contribute to a number of public health concerns in addition to the MMR.

In 2021, approximately 5 million children died before reaching their fifth birthday from mostly preventable causes (8).² The leading causes of preventable deaths of children under 5 years old globally include (12):

• Premature birth and birth complications (such as birth asphyxia/trauma)
• Acute respiratory infections
• Diarrhea
• Malaria

While the research does look collectively at children under five years old, it also drills into data on different age groups, helping to illuminate key points for intervention. For example, neonatal deaths are associated with causes of death related to antenatal care and the birth process, while deaths beyond the first month and prior to age 5 are more related to communicable diseases in low- and middle-income countries (12).²

Without urgent action to reduce the U5MR, more than 50 countries will not meet the under-five mortality target by 2030 and more than 60 countries will miss the neonatal mortality target (5).² Of countries predicted to miss the target, 75 percent are located in sub-Saharan Africa, 87 percent are classified as low- or lower-middle-income and half are considered to be in fragile and conflict-affected situations (18). It is, however, important to note that despite limited resources several countries have made substantial progress in reducing the national U5MR. Eritrea, Ethiopia, Malawi and Uganda, which are classified as low-income countries, along with 15 lower-middle-income countries like Bangladesh, Mongolia and Uzbekistan, have reduced under-five mortality by more than 75 per cent since 1990 (19).² Highlighting these gains is critical to illustrate both that it is indeed possible to lower child mortality rates in less wealthy countries and to emphasize that these countries are where resources could make the biggest impact to reaching the global goal.

As is written in the MMEIG report, work toward lower maternal and child mortality rates can’t be delayed. “With half of the SDG period remaining, the time is now to intensity efforts and renew the commitment to end preventable maternal mortality, and to ensure women not only simply survive a pregnancy but are healthy and thrive,” (51).¹ Hone your skills and drive a career in public health with an online Bachelor of Science in Public Health or Master of Public Health (MPH) from Kent State University.

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