MANILA, Philippines – Despite significant improvement in maternal survival for the last two decades, the world still failed to meet the Millennium Development Goal (MDG) on maternal health.

“Significant progress has been made, but it fell far short of the global goal and targets,” the United Nations (UN) said in its final MDG report.

From the global maternal mortality ratio of 380 deaths per 100,000 live births in 1990, the number is now down to 210. But the goal was to reduce the number by three quarters, or down to 95 deaths.

In 2013, about 289,000 mothers died – or 800 women per day. Eighty-six percent of them lived in the sub-Saharan Africa and Southern Asia. The maternal mortality ratio is 14 times higher in developing regions compared to developed ones. (READ: Maternal deaths falling, but not fast enough: WHO)

Data from 2003 to 2009 showed that hemorrhage caused the greatest number of maternal deaths both in developing (27%) and developed (16%) regions. Other major complications include infections, high blood pressure during pregnancy, complications from delivery, and unsafe abortion.

Health services

Meanwhile, the percentage of deliveries attended by skilled health workers  (doctor, nurse, midwife) increased from 59% in 1990, to 71% in 2014. 

But the UN said this “modest” progress reflects “lack of universal access to care.”

“Profound inequalities in access to and use of reproductive health services persist within and across regions,” the report said.

In developing regions, the gap is huge (31%) between urban and rural areas when it comes to coverage of births attended by skilled health workers. In Central Africa alone, the gap is at 52%.

What’s more, progress has been “slow” in increasing the number of women receiving the recommended amount of care they need during pregnancy.

The World Health Organization recommends a minimum of 4 antenatal care visits, but what happens during these visits?

“Women should receive at least a basic care package, including nutritional advice. They should also be alerted to warning signs indicating possible problems during their pregnancy and get support in planning a safe delivery,” the report said.

But in 2014, only 52% (average) of pregnant women in developing regions were able to complete the 4 visits.

As for contraceptive use, the world saw in the past 25 years an increase in the percentage of women who delay their pregnancy using any method of contraception.

“Use of contraception contributes to reducing the number of unintended pregnancies, unsafe abortions and maternal deaths,” the report said. (READ: Women, are your reproductive rights protected?)

However, 12% of women worldwide still have unmet contraceptive needs.

The UN also reported a decline in the birth rate among adolescent girls aged 15 to 19, from 59 births per 1,000 girls in 1990 to 51 births in 2015.

Progress has been “most dramatic” in Eastern Asia, Oceania, and Southern Asia. What works is increasing opportunities for girls to go to school and get paid employment – efforts that also help reduce poverty and achieve greater gender equality and women empowerment.

“Adolescent childbearing can have harmful consequences for the health of both adolescent girls and the children they bear. Early childbearing also reflects broader forms of social and economic marginalization of girls,” the report said. 

‘Insufficient, greatly uneven progress’

Beyond 2015, countries need to strengthen their capacity to improve availability and accessibility of data related to maternal health: births, deaths, cause of death, and health service coverage.

To date, only 51% of countries worldwide have “some data” on maternal causes of death, the UN lamented.

Information on maternal health is vital not only to establish “informed policy priorities” on national, regional, and global health, but also to measure improvements in maternal health and universal access to sexual and reproductive health care.

For now, the agenda on maternal health is far from over – not when the progress is still “insufficient and greatly uneven.”

“Large inequities remain in maternal health, along with gaps in access to and use of sexual and reproductive health services that must be consistently addressed and monitored,” the report said. – Rappler.com

Pregnant belly image via Shutterstock