Hogan, Margaret, Kyle Foreman, Mohsen Naghavi, Stephanie Ahn, Mengru Wang, Susanna Makela, Alan Lopez, Rafael Lozano, and Christopher Murray. “Maternal Mortality for 181 Countries, 1980–2008: A Systematic Analysis of Progress towards Millennium Development Goal 5.” Lancet 375, no. 9726 (May 8, 2010): 1609-23. doi:10.1016/S0140-6736(10)60518-1.

URL: www.thelancet.com/article/S0140-6736(10)60518-1/abstract

ABSTRACT:

Maternal mortality remains a major challenge to health systems worldwide. Reliable information about the rates and trends in maternal mortality is essential for resource mobilisation, and for planning and assessment of progress towards Millennium Development Goal 5 (MDG 5), the target for which is a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015. We assessed levels and trends in maternal mortality for 181 countries.

Hogan Study: In this landmark study, Hogan, et al use sophisticated statistical analysis to examine changes in the maternal mortality rate (MMR) in 181 countries between the years 1980-2008. Researchers were encouraged to find that the MMR had dropped more than expected in several key areas of the world, although only 23 countries were on track to achieve the 75% reduction in MMR set out in MDG5. Over 50% of worldwide maternal deaths were concentrated in only 6 countries: India, Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo. Factors found to be statistically associated with reductions in maternal mortality included economic status and education, which in turn affect the total fertility rate.  The authors also speculate, but were unable to precisely determine, that the increased presence of skilled birth attendants may have contributed to reductions in MMR. Conversely, the HIV epidemic had an adverse effect on maternal mortality, particularly in sub-Saharan Africa, where the effects of the epidemic may have masked parallel progress in maternal health. Significantly, although the authors do not discuss this finding directly, access to abortion does not seem to correlate with reductions in maternal mortality by country, although additional, formal statistical analysis will be required to verify this.