Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

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Study Justification:
The study aims to assess progress in reducing maternal mortality worldwide, identify areas of success and remaining challenges, and inform policy discussions. This is important as we transition from the Millennium Development Goal to the Sustainable Development Goal era.
Highlights:
– Only ten countries achieved Millennium Development Goal 5, while 122 countries have already met Sustainable Development Goal 3.1.
– Geographical disparities in maternal mortality widened between 1990 and 2015, with 24 countries still having a maternal mortality ratio greater than 400.
– The proportion of maternal deaths in the bottom two socio-demographic index quintiles increased from 68% in 1990 to over 80% in 2015.
– The middle socio-demographic index quintile showed the most improvement but also had the most complicated causal profile.
– Maternal mortality in the highest socio-demographic index quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage.
– Achieving Sustainable Development Goal 3.1 will require high coverage of antenatal care visits, in-facility delivery, skilled birth attendance, and family planning services.
Recommendations:
– Establish or renew systems for collection and timely dissemination of health data.
– Expand coverage and improve quality of family planning services, including access to contraception and safe abortion, to address high adolescent fertility.
– Invest in improving health system capacity, including routine reproductive health care and advanced obstetric care.
– Adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high socio-demographic index locations.
– Examine performance with respect to socio-demographic index level and formulate strategies to improve reproductive health.
Key Role Players:
– Government health departments and ministries
– International organizations (e.g., World Health Organization, United Nations Population Fund)
– Non-governmental organizations (NGOs) working in reproductive health
– Health professionals and providers
– Researchers and academics
Cost Items for Planning Recommendations:
– Data collection and analysis
– Training and capacity building for health workers
– Infrastructure development for health facilities
– Family planning services and supplies
– Obstetric care equipment and supplies
– Monitoring and evaluation systems
– Research and program evaluation
– Advocacy and awareness campaigns

The strength of evidence for this abstract is 9 out of 10.
The evidence in the abstract is strong because it is based on a systematic analysis of global, regional, and national levels of maternal mortality from 1990 to 2015. The study used data from 186 countries and territories, with 11 of them analyzed at the subnational level. The study also quantified underlying causes of maternal death and examined drivers of trends. The evidence is further supported by secondary analyses and historical patterns. To improve the evidence, the abstract could provide more details on the specific data sources used and the estimation methods employed.

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can provide remote access to healthcare professionals, allowing pregnant women in remote or underserved areas to receive prenatal care and consultations without having to travel long distances.

2. Mobile health (mHealth) applications: Developing mobile applications that provide educational resources, appointment reminders, and personalized health information can empower pregnant women to take control of their own health and make informed decisions.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, education, and support to pregnant women in their communities can help bridge the gap in access to maternal health services, especially in rural areas.

4. Maternal health clinics: Establishing dedicated maternal health clinics that offer comprehensive prenatal care, delivery services, and postnatal care can ensure that pregnant women have access to the necessary healthcare services in a safe and supportive environment.

5. Transportation solutions: Improving transportation infrastructure and implementing transportation programs specifically designed for pregnant women can help overcome geographical barriers and ensure timely access to healthcare facilities.

6. Financial incentives: Providing financial incentives, such as cash transfers or subsidies, to pregnant women who seek prenatal care and deliver in healthcare facilities can help reduce financial barriers and increase utilization of maternal health services.

7. Data collection and analysis: Investing in robust health data collection systems and analysis can help identify gaps in access to maternal health services, monitor progress, and inform evidence-based decision-making for targeted interventions.

These are just a few examples of potential innovations that can be explored to improve access to maternal health. Each innovation should be carefully evaluated and tailored to the specific context and needs of the population it aims to serve.
AI Innovations Description
Based on the description provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Strengthening Health Data Systems: Establish or renew systems for collection and timely dissemination of health data. This can be achieved by implementing innovative technologies such as electronic health records, mobile health applications, and data analytics to improve data collection, analysis, and reporting. This will enable healthcare providers and policymakers to have real-time access to accurate and comprehensive maternal health data, leading to better decision-making and resource allocation.

2. Expanding Family Planning Services: Expand coverage and improve the quality of family planning services, including access to contraception and safe abortion, to address high adolescent fertility rates. This can be done by implementing innovative approaches such as mobile clinics, community-based distribution of contraceptives, and telemedicine services to reach remote and underserved areas. Additionally, integrating family planning services with other reproductive health services can improve accessibility and uptake.

3. Enhancing Health System Capacity: Invest in improving health system capacity, including coverage of routine reproductive health care and more advanced obstetric care, including Emergency Obstetric Care (EmOC). This can be achieved by training and deploying skilled healthcare professionals, improving infrastructure and equipment, and strengthening referral systems. Innovative approaches such as task-shifting, telemedicine consultations, and mobile health teams can help overcome geographical barriers and improve access to quality maternal health services.

4. Addressing Indirect and Late Maternal Deaths: Adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high Socio-demographic Index (SDI) locations. This can be done by implementing innovative strategies such as maternal death audits, community-based surveillance systems, and continuous quality improvement initiatives. These approaches can help identify and address the underlying causes of maternal deaths, leading to improved outcomes.

5. Performance Monitoring and Improvement: Examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. This can be achieved by implementing innovative monitoring and evaluation systems, including dashboards and scorecards, to track progress and identify areas for improvement. Additionally, fostering collaboration and knowledge-sharing among countries can facilitate the exchange of best practices and lessons learned.

By implementing these recommendations as innovative solutions, access to maternal health can be improved, leading to a reduction in maternal mortality rates and better overall reproductive health outcomes.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Telemedicine: Implementing telemedicine programs can provide remote access to healthcare professionals, allowing pregnant women in remote or underserved areas to receive prenatal care and consultations without the need for travel.

2. Mobile health (mHealth) applications: Developing mobile applications that provide information on prenatal care, nutrition, and warning signs during pregnancy can empower women to take better care of their health and seek timely medical assistance when needed.

3. Community health workers: Training and deploying community health workers can help bridge the gap between healthcare facilities and pregnant women in rural or marginalized communities. These workers can provide education, support, and referrals for maternal health services.

4. Transportation support: Lack of transportation can be a significant barrier to accessing maternal health services. Providing transportation support, such as subsidized or free transportation services, can ensure that pregnant women can reach healthcare facilities for prenatal care, delivery, and postnatal care.

5. Maternal waiting homes: Establishing maternal waiting homes near healthcare facilities can provide a safe and comfortable place for pregnant women to stay as they approach their due dates. This can reduce the risk of complications during childbirth by ensuring timely access to healthcare.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Gather data on the current state of maternal health access, including maternal mortality rates, healthcare facility coverage, availability of prenatal care, and transportation infrastructure.

2. Define indicators: Identify key indicators that reflect access to maternal health, such as the percentage of pregnant women receiving prenatal care, the distance to the nearest healthcare facility, and the availability of transportation options.

3. Model development: Develop a simulation model that incorporates the collected data and defines the relationships between the recommendations and the indicators. This model should consider factors such as population demographics, geographical distribution, and existing healthcare infrastructure.

4. Scenario analysis: Run the simulation model with different scenarios that represent the implementation of the recommendations. For example, simulate the impact of increasing the number of community health workers or providing transportation support.

5. Analyze results: Analyze the simulation results to assess the potential impact of the recommendations on improving access to maternal health. This analysis can include changes in the indicators, such as increased coverage of prenatal care or reduced distance to healthcare facilities.

6. Policy formulation: Based on the simulation results, formulate policies and strategies to implement the recommendations that have shown the most significant positive impact on improving access to maternal health.

It is important to note that the methodology for simulating the impact may vary depending on the available data, resources, and specific context.

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