Limitations of global estimates of maternal mortality – Nepal

15/06/2012 Comments Off on Limitations of global estimates of maternal mortality – Nepal

The latest United Nations publication on global estimates of maternal mortality was released in May this year. Some of the news from this report is good, that despite big regional variations, overall maternal mortality is reducing at a global level.

One limitation of the estimates is that they fail to shine a light on the stark disparities between countries, some of which have made little if any progress, or within countries, for example between women living in rural and urban areas. They mask inequity in access for poorer women which characterises health service provision in many countries, and which remains a huge stumbling block to tackling the preventable causes of maternal death.

There is also concern that different estimates from a range of sources confuse the picture for those in the field; that the estimates cannot provide a comprehensive understanding of what works or how to explain reductions in maternal deaths – information which is essential if further progress is to be made;  and, most worryingly, that the perception of success in reducing maternal deaths may lead to complacency or neglect of the problem.


In Nepal, maternal mortality has reduced from 770 to 170 deaths per 100,000 live births between 1990 and 2010, thus reaching the 75% reduction MDG target for 2015. The new estimates are only one of a series of different estimates released and published. The others were published in the Lancet and by WHO here, here and here.

These papers report different estimates of maternal mortality (calculated using different methods) relevant to approximately the same period of time. On the surface, the estimated reductions in Nepal should be reason for optimism, especially as all the estimates suggest a falling trend of maternal deaths in Nepal. But these new estimates have caused confusion and frustration in Nepal.

The confusion arises because the estimates do not agree, so it is not possible to say what the current level of maternal mortality is. Some people believe that the estimates report improbably low levels of maternal mortality and a larger than expected reduction over the last two decades, given the difficult geographical terrain, relatively low access to maternity services and variable standards of care in Nepal. Their frustration arises from the difficulty in interpreting these estimates to ensure that maternal and reproductive health services do not become neglected.

Maternal mortality is notoriously difficult to measure . For now, Nepal will have to deal with the uncertainty of the estimates, at least until the national demographic and health survey planned for 2016 provides more data for better estimates. Instead of debating what the actual level of mortality is or which estimate to use, what needs to be done is to draw on the situation to generate interest in finding out why the reduction is occurring. First steps have been made to do this , but more evidence needs to be gathered to build up a convincing picture of what changes are being experienced in Nepal. The reasons we find may not necessarily be what we might assume or expect, and will provide valuable lessons for other countries still striving to reduce maternal deaths.

A guest blog by Julia Hussein

Senior Clinical Research Fellow Immpact,
Scientific Director Ipact, University of Aberdeen, UK

Reproductive Health Matters

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