Goal 5: Improving maternal health

The goal is to reduce the maternal mortality ratio by three quarters between 1990 and 2015.

The maternal mortality ratio is the number of deaths per 100,000 live births. Progress towards improving maternal health is also measured by the proportion of births attended by trained health care workers.

Since 2008, there has been a new goal in this area: to achieve, by 2015, universal access to reproductive health. The indicators are adolescent birth rate, antenatal care coverage and coverage of family planning needs.

Trend in the number of deaths per 100,000 live births

More than 500,000 women die every year during pregnancy or childbirth. More than 99 per cent of these women live in developing countries, where the number of deaths per 100,000 live births was on average 450 in 2005. But there are big differences between the regions. Sub-Saharan Africa had the highest rate in 2005, at 900. Thus, a woman's risk of dying during delivery is 1:16 in an African country south of the Sahara, compared with 1:3,800 in an industrial country. In the Middle East and North Africa, the maternal mortality ratio was 160 per 100,000 live births, and in South Asia 490.

By preventing unwanted pregnancies one quarter of all deaths during pregnancy or childbirth could be avoided. This includes deaths following abortion as well as the high mortality rate among under-age mothers.

Trend in the use of birth attendants

Complications in childbirth are, in developing countries, among the leading causes of death in women between the ages of 15 and 49. Many of these deaths could be prevented through better basic medical care. Between 1990 and 2006, the proportion of births attended by skilled health personnel in developing countries as a whole rose from 47 to 61 per cent. The best progress was achieved in North Africa, where the proportion rose from 40 to 79 per cent, and in East Asia, where the proportion went up from 48 to 73 per cent. In sub-Saharan Africa, the proportion of births attended by skilled health personnel rose from 42 per cent in 1990 to only 47 per cent in 2006. According to surveys in 57 developing countries, between 1996 and 2005, 81 per cent of deliveries in urban areas were attended by skilled health personnel, compared with only 49 per cent in rural areas.

There is also a large gap between the poor and rich sectors of the population. In countries in which medical care is generally scarce, women in the highest income bracket are six times more likely to have access to medically trained birth attendants than women in the lowest income bracket.

Trend in access to reproductive health services

Antenatal care provided by doctors has been made more widely available in recent years. Almost three quarters of all women in developing countries visit a doctor at least once for a check-up during pregnancy, an increase of 20 per cent over 1990. The World Health Organization and UNICEF, however, recommend at least four check-ups in the course of a pregnancy. Only 42 per cent of women in Africa achieve this figure.

Globally, the number of adolescent pregnancies declined slightly. By far the lowest rate – as well as the biggest drop (by almost 75 per cent since 1990) – was achieved by East Asia, with 5 births per 1,000 women between the ages of 15 and 19.

At the other end of the scale are the sub-Saharan countries, where 119 in every 1,000 births are to adolescent women. There is no sign of any significant reversal of this trend: In 1990 the figure was 131, and in 2000 118. At a lower level, but showing no significant improvement in nearly two decades either, is the Latin American and Caribbean region, where the reduction was only small: from 77 to 73 births between 1990 and 2006.