As the 2015 target date for the Millennium Development Goals (MDGs) nears, ending preventable maternal mortality (EPMM) remains an unfinished agenda and one of the world’s most critical challenges despite significant progress over the past decade. Although maternal deaths worldwide have decreased by 45% since 1990, 800 women still die each day from largely preventable causes before, during, and after the time of giving birth. Ninety-nine per cent of preventable maternal deaths occur in low- and middle-income countries (1). Within countries, the risk of death is disproportionately high among the most vulnerable segments of society. Maternal health, wellbeing and survival must remain a central goal and an investment priority in the post-2015 framework for sustainable development to ensure that progress continues and accelerates, with a focus on reducing inequities and discrimination. Attention to maternal mortality and morbidity must be accompanied by improvements along the continuum of care for women and children, including commitments to sexual and reproductive health and newborn and child survival.
The time is now to mobilize global, regional, national and community-level commitment for EPMM. Analysis suggests that “a grand convergence” is within our reach, when through concerted efforts we can eliminate wide disparities in current maternal mortality and reduce the highest levels of maternal deaths worldwide (both within and between countries) to the rates now observed in the best-performing middle-income countries (2). To do so would be a great achievement for global equity and reflect a shared commitment to a human rights framework for health.
High-functioning maternal health programmes require awareness of a changing epidemiological landscape in which the primary causes of maternal death shift as maternal mortality ratios (MMRs) decline, described as “obstetric transition”(3). Strategies to reduce maternal mortality must take into account changing patterns of fertility and causes of death. The ability to count every maternal and newborn death is essential for understanding immediate and underlying causes of these deaths and developing evidence-informed, context-specific programme interventions to avert future deaths.
The EPMM targets and strategies are grounded in a human rights approach to maternal and newborn health, and focus on eliminating significant inequities that lead to disparities in access, quality and outcomes of care within and between countries. Concrete political commitments and financial investments by country governments and development partners are necessary to meet the targets and carry out the strategies for EPMM.