THE World Health Organization (WHO) has just put out a report on Trends in maternal mortality: 1990 to 2010, with collaboration from WHO, UNICEF, UNFPA and The World Bank estimates. And today’s Perspectives will draw from this report. Some may recall that after the UN Secretary-General set up the Millennium Development Goals 4 and 5, it established the Commission on Information and Accountability for Women and Children’s Health (CIAWCH) to “determine the most effective international institutional arrangements for global reporting, oversight and accountability on women and children’s health.” (CIAWCH)
The CIAWCH report has 10 recommendations. CIAWCH noted that a major recommendation to enhance the measurement of maternal and child deaths is that “by 2015, all countries have taken significant steps to establish a system for registration of births, deaths and causes of death, and have well-functioning health information systems that combine data from facilities, administrative sources and surveys.”

Only about a third of the countries have  adequate civil registration systems with accurate attribution of deaths. Clearly then, a large number of countries has a lot of work to do to measure up to the recommendations of this report, and in the end stave off unnecessary maternal and child deaths. And this effort will be a great step forward to realise the Millennium Development Goal 5 (MDG 5)-improve maternal health. There are two targets for appraising MDG 5: reduce maternal mortality ratio by 75% between 1990 and 2015, and by 2015, reaching a state of universal access to reproductive health.
The report indicated that about 287,000 maternal deaths globally happened in 2010, representing a 47% reduction in maternal deaths from 1990. Most of these maternal deaths occurred in Sub-Saharan Africa (56%) and Southern Asia (29%), that is, these two regions had 85% of maternal deaths. Estimates of maternal mortality ratio (MMR), that is, maternal deaths per 100,000 live births for 2010 showed that Latin America would have had 72 and the Caribbean 190 maternal deaths per 100,000 live births.
The report assessed 180 countries and territories for 1990 through 2010. During this period, 154 countries showed reduced MMRs, while  26 experienced increases in their MMRs. Interestingly, during this period 1990 to 2010, 10 countries (Estonia, Maldives, Belarus, Romannia, Bhutan, Equatorial Guinea, Iran, Lithuania, Nepal, and Vietnam) already had achieved 75% reduction in MMRs, and, therefore, met the MDG 5, long before the target date of 2015. These are not developed countries in the same league as of the U.S., UK, Germany, Japan, etc., suggesting that, perhaps, income/wealth may have an overestimated impact on MMRs.
The WHO report goes on to say that one method of determining how other countries are progressing toward the MDG 5 is to find out if they had an annual reduction of 5.5% in their MMRs between 1990 and 2010; and during this same period, countries that had 5.5% or  more in their MMRs were seen as being “on track” toward the MDG 5; those with reductions of 2% to 5.5% MMRs were “making progress”; and those under 2% MMRs were making “insufficient progress”; and countries with increasing MMRs were not “making progress”.
The global performance for MMR between 1990 and 2010 was an annual reduction of 3.1%, meaning globally, countries are “making progress’ in their MMRs. This report also shows that apart from the 10 countries that already met the MDG 5, nine other countries are “on track”; and these are Eritrea, Oman, Egypt, Timor-Leste, Bangladesh, China, Lao, Syria, and Cambodia; again we are seeing a major trend where several poor countries are doing well in their MMRs.
Countries in the Caribbean showed the following annual percentage change in their MMRs between 1990 and 2010: The Bahamas -0.4%; Barbados -4.0%; Grenada -1.8%; Guyana 2.1%; Haiti -2.7%; Jamaica 3.3%; Suriname 2.2%; Trinidad & Tobago -3.1%.
Globally, the report indicates that strengthened health systems, increase in female education, and physical accessibility to health clinics have played some role in reducing MMRs, among other factors.