The United States is among just eight countries in the world to experience an increase in maternal mortality since 2003 – joining Afghanistan and countries in Africa and Central America, according to a new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
The study, "Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013," published May 2 in The Lancet, ranked the United States number 60 in the list of 180 countries on maternal deaths, compared to its rank of 22 in 1990, demonstrating how it has fallen behind globally. By contrast, China rose to number 57, up from number 116 in 1990.
In the US, 18.5 mothers died for every 100,000 live births in 2013, more than double the figures for maternal mortality in Saudi Arabia (7) and Canada (8.2), and more than triple that for the United Kingdom (6.1).
The biggest increase in maternal mortality by age group occurred in women 20-24. In 1990, 7.2 women in this age group died for every 100,000 live births and in 2013, 14 died for every 100,000 live births.
The study findings focus on measuring the trends in maternal mortality, but the researchers offer a range of possible explanations for the disparities between the US and other countries, including lack of access to prenatal care and other health services, high rates of caesarian section deliveries, and pregnancies complicated by obesity, diabetes, and other conditions.
"For American women, high-risk pregnancies and the number of women with inadequate access to preventive and maternal health care are just two potential causes of this trend," said study author Dr. Nicholas Kassebaum, Assistant Professor at IHME. "The good news is that most maternal deaths are preventable, and we can do better."
The first installment in IHME's new updates to the Global Burden of Disease (GBD) study finds that globally, maternal deaths fell significantly between 1990 and 2013, but 293,000 women still died in 2013 from pregnancy-related causes. In the US, 796 women died in 2013.
The vast majority of countries have seen accelerated reductions in maternal mortality – with maternal deaths declining by 2.7% per year since 2003.
The leading cause of maternal death globally is medical complications of childbirth and the period post-delivery. Approximately one-quarter of maternal deaths were found to occur during childbirth and the 24 hours following. Another quarter happen during pregnancy, and the remaining deaths occur up to one year after delivery.
A separate study also released on May 2 in The Lancet examined child survival rates and found that 28,000 children under age 5 died in the United States in 2013. Child death rates in the US declined throughout 1990-2013, but the pace of the declines has slowed. During the 1990s, child mortality declined 3.2% annually, and after 2000, the rate slowed to 1.7%.
The results appeared in "Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013."
The study finds that child death rates dropped by 48% globally between 1990 and 2013. However, 6.3 million children still died before their fifth birthday in 2013. Most countries have seen faster declines in child deaths – with child deaths declining by 3.5% per year since 2000.
The study on child mortality shows that maternal education and income growth have had a significant impact in reducing child deaths. In addition, there is a strong trend in rich and poor countries that appears to be related to technological and other advances, such as vaccine and drug innovations.
A separate IHME study found that donor spending on maternal and child health grew substantially since 2000, indicating that the decline in deaths comes at a time of increased investment.
"There's no reason that a country with the resources and the medical expertise that the US has should see maternal deaths going up," said Dr. Christopher Murray, Director of IHME and a co-founder of the Global Burden of Disease. "The next step would be to examine local-level differences in maternal deaths to look for patterns and the drivers behind those patterns."
For children, the data show that the earliest days of life are the most dangerous. In 2013, nearly 42% of global child deaths occurred in infants less than one month old. The 10 countries with the lowest child survival rates were all in sub-Saharan Africa.
The studies also present scenarios to forecast the under-5 mortality rate and maternal mortality in 2030.
The trends show that it's possible for millions of children's lives to be saved in a short amount of time. If current trends persist, there would be 3.8 million child deaths worldwide in 2030. Under the most ambitious child mortality scenario, though – if all countries saw declines as strong as the countries that saw the fastest declines – there would be 2.4 million child deaths in 2030. The expected number of maternal deaths by 2030 globally is 184,000, and 53 countries will still have maternal mortality ratios over 100.