New findings for maternal mortality age patterns: aggregated results for 38 countries

Abstract

Background: With recent results showing a global decline in overall maternal mortality during the last two decades and with the target date for achieving the Millennium Development Goals only four years away, the question of how to continue or even accelerate the decline has become more pressing. By knowing where the risk is highest as well as where the numbers of deaths are greatest, it may be possible to re-direct resources and fine-tune strategies for greater effectiveness in efforts to reduce maternal mortality.

Methods: We aggregate data from 38 Demographic and Health Surveys that included a maternal mortality module and were conducted in 2000 or later to produce maternal mortality ratios, rates, and numbers of deaths by five year age groups, separately by residence, region, and overall mortality level.

Findings: The age pattern of maternal mortality is broadly similar across regions, type of place of residence, and overall level of maternal mortality. A "J" shaped curve, with markedly higher risk after age 30, is evident in all groups. We find that the excess risk among adolescents is of a much lower magnitude than is generally assumed. The oldest age groups appear to be especially resistant to change. We also find evidence of extremely elevated risk among older mothers in countries with high levels of HIV prevalence.

Conclusions: The largest number of deaths occurs in the age groups from 20-34, largely because those are the ages at which women are most likely to give birth so efforts directed at this group would most effectively reduce the number of deaths. Yet equity considerations suggest that efforts also be directed toward those most at risk, i.e., older women and adolescents. Because women are at risk each time they become pregnant, fulfilling the substantial unmet need for contraception is a cross-cutting strategy that can address both effectiveness and equity concerns.

Figure 1. Maternal mortality ratios, all countries and low and high MMR groups.

The maternal mortality ratio (MMR) is the number of maternal deaths per 100,000 births. The maternal mortality ratio by age is shown for 38 developing countries combined (All), and for two sub-groups: countries where the overall MMR is >500 (High Group), and another that comprises countries where the overall MMR is <500 (Low Group).

Figure 2. Maternal mortality ratios, sub-Saharan African countries by HIV prevalence.

The maternal mortality ratio (MMR) is the number of maternal deaths per 100,000 births. Sub-Saharan African countries are grouped by the overall level of HIV prevalence in 2006 (the median year of the surveys analyzed). Countries are grouped into: high (>10%), medium (2–10%), and low (<2%) prevalence.

Figure 3. Maternal mortality rates, all countries and low and high MMR groups.

The maternal mortality rate is the number of maternal deaths per 1,000 women of reproductive age (15–49). The maternal mortality rate by age is shown for 38 developing countries combined (All), and for two sub-groups: countries where the overall maternal mortality ratio (MMR) is >500 (High Group), and another that comprises countries where the overall MMR is <500 (Low Group).

Figure 4. Percent distribution of maternal deaths for all countries, and low and high MMR groups.

The percent distribution is the percentage of total maternal deaths among women age 15–49 that occur in each five year age group. The distribution by age is shown for 38 developing countries combined (All), and for two sub-groups: countries where the overall maternal mortality ratio (MMR) is >500 (High Group), and another that comprises countries where the overall MMR is <500 (Low Group).