08:23am Monday 14 October 2019

TOG release: Global progress to address maternal mortality varies greatly, say experts

This new review looks at the progress India and Thailand have made and highlights the varying successes between the countries.

In September 2000 the Millennium Development Goals (MDGs) were created. Goal 5 has two main targets: to reduce the 1990 maternal mortality ratio by 75% and to achieve universal access to reproductive health care, including family planning and antenatal care, by 2015.

The most common causes of maternal death include haemorrhage, infections, hypertensive disorders, prolonged or obstructed labour and unsafe abortion.

While small improvements in maternal health have been made globally, progress is uneven states the review.

In India for example data obtained by the Sample Registration System shows there was an overall reduction in the maternal mortality ratio by 24% during the period from 1997–2003.

Although this is an improvement, progress is not uniform throughout the country, highlight the authors. The state of Kerala reported a maternal mortality ratio in 2001–2003 of 110 maternal deaths, in contrast with Uttar Pradesh, which reported a rate of 517.

The report also highlighted the fact that in India between 2002–2004, the majority of births (59%) still occurred at home and only 12% of these deliveries were attended by a health professional.

The government established the National Rural Health Mission in 2005 which targeted people living in rural areas with poor infrastructure or inadequate public health programmes. It aims to expand essential obstetric and newborn care including promoting antenatal visits, provision of safe delivery attended by a skilled professional and the provision of postnatal care.

In comparison, Thailand has made significant progress. Estimates from the United Nations suggest a reduction in maternal mortality ratio from 200 per 100 000 live births in 1990 to 110 per 100 000 in 2005.

In addition, data produced by the Ministry of Public Health in Thailand suggests that the maternal mortality ratio has reduced even more.

Much of this success is down to political and public commitment to the goals, government investment in universal social services, as well as economic expansion of the country. Differing from India, the vast majority of births in Thailand are attended by a health professional.

Professor Louise Kenny, Consultant Obstetrician and Gynaecologist, Cork University Maternity Hospital and co-author of the review said:

“Considerable progress has been made over the last 10 years and now with the deadline for the Millennium Development Goals fast approaching it is time to reaffirm the commitment to the values and goals envisioned in 2000 and work to make them a reality.

“Health professionals have an important part to play in reducing maternal mortality however the issues need to be addressed from a broader perspective and political commitment is essential.

“Public health programmes such as immunisation, nutritional and family planning campaigns have a significant impact on maternal health. Plus, more broadly, programmes that strengthen the infrastructure of a country have important health benefits as maternal health is linked to poverty, education, housing and access to facilities.”

TOG’s Editor –in-Chief, Jason Waugh said:

“This review is a valuable resource in looking at how far India and Thailand have come and what more needs to be done.

“There are clear variations between areas and more attention needs to be given to areas doing less well through government initiatives and relevant health programmes.”


For more information please contact Naomi Weston on 020 7772 6357 or nweston@rcog.org.uk


The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricians and Gynaecologists’ (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.


Gaensbauer R, Baker PN, Kenny LC. Saving mothers’ lives: progress in achieving Millennium Development Goal 5. The Obstetrician & Gynaecologist 2011;13:259–262.


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