Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Kassebaum, Nicholas J., Bertozzi-Villa, Amelia, Coggeshall, Megan S., Shackelford, Katya A., Steiner, Caitlyn, Heuton, Kyle R., Gonzalez-Medina, Diego, Barber, Ryan, Huynh, Chantal, Dicker, Daniel, Templin, Tara, Wolock, Timothy M., Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Abera, Semaw Ferede, Achoki, Tom, Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C., Agardh, Emilie E., Akena, Dickens, Alasfoor, Deena, Alemu, Zewdie Aderaw, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Al Kahbouri, Mazin J., Alla, François, Allen, Peter J., AlMazroa, Mohammad A., Alsharif, Ubai, Alvare, Elena, Alvis-Guzmán, Nelson, Amankwaa, Adansi A., Amare, Azmeraw T., Amini, Hassan, Ammar, Walid, Antonio, Carl A. T., Anwari, Palwasha, Ärnlöv, Johan, Arsenijevic, Valentina S. Arsic, Artaman, Ali, Asad, Majed Masoud, Asghar, Rana J, Assadi, Reza, Atkins, Lydia S., Badawi, Alaa, Balakrishnan, Kalpana, Basu, Arindam, Basu, Sanjay, Beardsley, Justin, Bed, Neeraj, Bekele, Tolesa, Bell, Michelle L., Bernabe, Eduardo, Beyene, Tariku J., Bhutta, Zulfi qar, Bin Abdulhak, Aref, Blore, Jed, Basara, Berrak Bora, Bose, Dipan, Breitborde, Nicholas, Cárdenas, Rosario, Castañeda-Orjuela, Carlos A., Castro, Ruben Estanislao, Catalá-López, Ferrán, Cavlin, Alanur, Chang, Jung-Chen, Che, Xuan, Christophi, Costas A., Chugh, Sumeet S., Cirillo, Massimo, Colquhoun, Samantha M., Cooper, Leslie Trumbull, Cooper, Cyrus, da Costa Leite, Iuri, Dandona, Lalit, Dandona, Rakhi, Davis, Adrian, Dayama, Anand, Degenhard, Louisa, De Leo, Diego, del Pozo-Cruz, Borja, Deribe, Kebede, Dessalegn, Muluken, deVeber, Gabrielle A., Dharmaratne, Samath D., Dilmen, Uğur, Ding, Eric L., Dorrington, Rob E., Drisco, Tim R., Ermakov, Sergei Petrovich, Esteghamati, Alireza, Faraon, Emerito Jose A., Farzadfar, Farshad, Felicio, Manuela Mendonca, Fereshtehnejad, Seyed-Mohammad, Ferreira de Limat, Graça Maria, Forouzanfart, Mohammad H., França, Elisabeth B., Gaffikin, Lynne, Gambashidze, Ketevan, Gbètoho Gankpé, Fortuné, Garcia, Ana C., Geleijnse, Johanna M., Gibney, Katherine B., Giroud, Maurice, Glaser, Elizabeth L., Goginashvil, Ketevan, Gona, Philimon, González-Castel, Dinorah, Goto, Atsushi, Gouda, Hebe N., Gugnani, Harish Chander, Gupta, Rahul, Gupta, Rajeev, Hafezi-Nejad, Nima, Hamadeh, Randah Ribhi, Hammami, Mouhanad, Hankey, Graeme J., Harb, Hilda L., Havmoeller, Rasmus, Hay, Simon, Heredia Pi, Ileana B., Hoek, Hans W., Hosgood, H. Dean, Hoy, Damian G., Husseini, Abdullatif, Idrisov, Bulat T., Innos, Kaire, Inoue, Manami, Jacobse, Kathryn H., Jahangir, Eiman, Ha Jee, Sun, Jensen, Paul N., Jha, Vivekanand, Jiang, Guohong, Juel, Knud, Kato Kabagambe, Edmond, Kan, Haidong, Karam, Nadim E., Karch, André, Kakizi Karema, Corine, Kaul, Anil, Kawakami, Norito, Kazanjan, Konstantin, Kazi, Dhruv S., Kemp, Andrew G., Kengne, Andre Pascal, Kereselidze, Maia, Khader, Yousef Saleh, Khalifa, Shams Eldin Ali Hassan, Khan, Ejaz Ahmed, Khang, Young-Ho, Knibbs, Luke, Kokubo, Yoshihiro, Kosen, Soewarta, Kuate Defo, Barthelemy, Kulkarni, Chanda, Kulkarni, Veena S., Kumar, G. Anil, Kumar, Kaushalendra, Kumar, Ravi B., Kwan, Gene, Lai, Taavi, Lalloo, Ratilal, Lam, Hilton, Lansingh, Van C., Larsson, Anders, Lee, Jong-Tae, Leigh, James, Leinsalu, Mall, Leun, Ricky, Li, Xiaohong, Li, Yichong, Li, Yongmei, Liang, Juan, Liang, Xiaofeng, Lim, Stephen S., Lin, Hsien-Ho, Lipshultz, Steven E., Liu, Shiwei, Liu, Yang, Lloyd, Belinda K., London, Stephanie J., Lotufo, Paulo A., Ma, Jixiang, Ma, Stefan, Machado, Vasco Manuel Pedro, Mainoo, Nana Kwaku, Majdan, Marek, Mapom, Christopher Chabila, Marcenes, Wagner, Marza, Melvin Barrientos, Mason-Jones, Amanda J., Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Memish, Ziad A., Mendoza, Walter, Miller, Ted R., Mills, Edward J., Mokdad, Ali H., Mola, Glen Liddell, Monasta, Lorenzo, de la Cruz Monis, Jonathan, Montañez Hernandez, Julio Cesar, Moore, Ami R., Mori, Rintaro, Mueller, Ulrich O., Mukaigawara, Mitsuru, Naheed, Aliya, Naidoo, Kovin S., Nand, Devina, Nangia, Vinay, Nash, Denis, Nejjar, Chakib, Nelson, Robert G., Neupane, Sudan Prasad, Newton, Charles R., Ng, Marie, Nieuwenhuijsen, Mark J., Nisar, Muhammad Imran, Nolte, Sandra, Norheim, Ole F., Nyakarahuka, Luke, Oh, In-Hwan, Ohkubo, Takayoshi, Olusanya, Bolajoko O., Omer, Saad B., Opio, John Nelson, Orisakwe, Orish Ebere, Pandian, Jeyaraj D., Papachristou, Christina, Park, Jae-Hyun, Paternina Caicedo, Angel J., Patten, Scott B., Pau, Vinod K., Pavlin, Boris Igor, Pearce, Neil, Pereira, David M., Pesudovs, Konrad, Petzold, Max, Poenaru, Dan, Polanczyk, Guilherme V., Polind, Suzanne, Pope, Dan, Pourmalek, Farshad, Qato, Dima, Quistberg, D. Alex, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Sajjad ur, Raju, Murugesan, Rana, Saleem M., Refaatk, Amany, Ronfani, Luca, Roy, Nobhojit, Sánchez Pimienta, Tania Georgina, Sahraian, Mohammad Ali, Salomon, Joshua, Sampson, Uchechukwu, Santos, Itamar S., Sawhney, Monika, Sayinzoga, Felix, Schneider, Ione J. C., Schumacher, Austin, Schwebel, David C., Seedat, Soraya, Sepanlou, Sadaf G., Servan-Mori, Edson E., Shakh-Nazarova, Marina, Sheikhbahaei, Sara, Shibuya, Kenji, Shin, Hwashin Hyun, Shiue, Ivy, Sigfusdottir, Inga Dora, Silberberg, Donald H., Silva, Andrea P., Singh, Jasvinder A., Skirbekk, Vegard, Sliwa, Karen, Soshnikov, Sergey S., Sposato, Luciano A., Sreeramareddy, Chandrashekhar T., Stroumpoulis, Konstantinos, Sturua, Lela, Sykes, Bryan L., Tabb, Karen M., Talongwa, Roberto Tchio, Tan, Feng, Teixeira, Carolina Maria, Tenkorang, Eric Yeboah, Terkawi, Abdullah Sulieman, Thorne-Lyman, Andrew L., Tirschwell, David L., Towbin, Jeffrey A., Tran, Bach X., Tsilimbaris, Miltiadis, Uchendu, Uche S., Ukwaja, Kingsley N., Undurraga, Eduardo A., Uzun, Selen Begüm, Vallely, Andrew J., van Gool, Coen H., Vasankari, Tommi J., Vavilala, Monica S., Venketasubramanian, N., Villalpando, Salvador, Violante, Francesco S., Vlassov, Vasiliy Victorovich, Vos, Theo, Waller, Stephen, Wang, Haidong, Wang, Linhong, Wang, Sharon XiaoRong, Wang, Yanping, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G., Westerman, Ronny, Wilkinson, James D., Woldeyohannes, Solomon Meseret, Wong, John Q., Wordofa, Muluemebet Abera, Xu, Gelin, Yang, Yang C., Yano, Yuichiro, Yentur, Gokalp Kadri, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z., Yu, Chuanhua, Jin, Kim Yun, Zak, Maysaa El Sayed, Zhao, Yong, Zheng, Yingfeng, Zhou, Maigeng, Zhu, Jun, Zou, Xiao Nong, Lopez, Alan D., Naghavi, Mohsen, Murray, Christopher J. L. and Lozano, Rafael (2014) Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384 9947: 980-1004. doi:10.1016/S0140-6736(14)60696-6


Author Kassebaum, Nicholas J.
Bertozzi-Villa, Amelia
Coggeshall, Megan S.
Shackelford, Katya A.
Steiner, Caitlyn
Heuton, Kyle R.
Gonzalez-Medina, Diego
Barber, Ryan
Huynh, Chantal
Dicker, Daniel
Templin, Tara
Wolock, Timothy M.
Ozgoren, Ayse Abbasoglu
Abd-Allah, Foad
Abera, Semaw Ferede
Achoki, Tom
Adelekan, Ademola
Ademi, Zanfina
Adou, Arsène Kouablan
Adsuar, José C.
Agardh, Emilie E.
Akena, Dickens
Alasfoor, Deena
Alemu, Zewdie Aderaw
Alfonso-Cristancho, Rafael
Alhabib, Samia
Ali, Raghib
Al Kahbouri, Mazin J.
Alla, François
Allen, Peter J.
AlMazroa, Mohammad A.
Alsharif, Ubai
Alvare, Elena
Alvis-Guzmán, Nelson
Amankwaa, Adansi A.
Amare, Azmeraw T.
Amini, Hassan
Ammar, Walid
Antonio, Carl A. T.
Anwari, Palwasha
Ärnlöv, Johan
Arsenijevic, Valentina S. Arsic
Artaman, Ali
Asad, Majed Masoud
Asghar, Rana J
Assadi, Reza
Atkins, Lydia S.
Badawi, Alaa
Balakrishnan, Kalpana
Basu, Arindam
Basu, Sanjay
Beardsley, Justin
Bed, Neeraj
Bekele, Tolesa
Bell, Michelle L.
Bernabe, Eduardo
Beyene, Tariku J.
Bhutta, Zulfi qar
Bin Abdulhak, Aref
Blore, Jed
Basara, Berrak Bora
Bose, Dipan
Breitborde, Nicholas
Cárdenas, Rosario
Castañeda-Orjuela, Carlos A.
Castro, Ruben Estanislao
Catalá-López, Ferrán
Cavlin, Alanur
Chang, Jung-Chen
Che, Xuan
Christophi, Costas A.
Chugh, Sumeet S.
Cirillo, Massimo
Colquhoun, Samantha M.
Cooper, Leslie Trumbull
Cooper, Cyrus
da Costa Leite, Iuri
Dandona, Lalit
Dandona, Rakhi
Davis, Adrian
Dayama, Anand
Degenhard, Louisa
De Leo, Diego
del Pozo-Cruz, Borja
Deribe, Kebede
Dessalegn, Muluken
deVeber, Gabrielle A.
Dharmaratne, Samath D.
Dilmen, Uğur
Ding, Eric L.
Dorrington, Rob E.
Drisco, Tim R.
Ermakov, Sergei Petrovich
Esteghamati, Alireza
Faraon, Emerito Jose A.
Farzadfar, Farshad
Felicio, Manuela Mendonca
Fereshtehnejad, Seyed-Mohammad
Ferreira de Limat, Graça Maria
Forouzanfart, Mohammad H.
França, Elisabeth B.
Gaffikin, Lynne
Gambashidze, Ketevan
Gbètoho Gankpé, Fortuné
Garcia, Ana C.
Geleijnse, Johanna M.
Gibney, Katherine B.
Giroud, Maurice
Glaser, Elizabeth L.
Goginashvil, Ketevan
Gona, Philimon
González-Castel, Dinorah
Goto, Atsushi
Gouda, Hebe N.
Gugnani, Harish Chander
Gupta, Rahul
Gupta, Rajeev
Hafezi-Nejad, Nima
Hamadeh, Randah Ribhi
Hammami, Mouhanad
Hankey, Graeme J.
Harb, Hilda L.
Havmoeller, Rasmus
Hay, Simon
Heredia Pi, Ileana B.
Hoek, Hans W.
Hosgood, H. Dean
Hoy, Damian G.
Husseini, Abdullatif
Idrisov, Bulat T.
Innos, Kaire
Inoue, Manami
Jacobse, Kathryn H.
Jahangir, Eiman
Ha Jee, Sun
Jensen, Paul N.
Jha, Vivekanand
Jiang, Guohong
Juel, Knud
Kato Kabagambe, Edmond
Kan, Haidong
Karam, Nadim E.
Karch, André
Kakizi Karema, Corine
Kaul, Anil
Kawakami, Norito
Kazanjan, Konstantin
Kazi, Dhruv S.
Kemp, Andrew G.
Kengne, Andre Pascal
Kereselidze, Maia
Khader, Yousef Saleh
Khalifa, Shams Eldin Ali Hassan
Khan, Ejaz Ahmed
Khang, Young-Ho
Knibbs, Luke
Kokubo, Yoshihiro
Kosen, Soewarta
Kuate Defo, Barthelemy
Kulkarni, Chanda
Kulkarni, Veena S.
Kumar, G. Anil
Kumar, Kaushalendra
Kumar, Ravi B.
Kwan, Gene
Lai, Taavi
Lalloo, Ratilal
Lam, Hilton
Lansingh, Van C.
Larsson, Anders
Lee, Jong-Tae
Leigh, James
Leinsalu, Mall
Leun, Ricky
Li, Xiaohong
Li, Yichong
Li, Yongmei
Liang, Juan
Liang, Xiaofeng
Lim, Stephen S.
Lin, Hsien-Ho
Lipshultz, Steven E.
Liu, Shiwei
Liu, Yang
Lloyd, Belinda K.
London, Stephanie J.
Lotufo, Paulo A.
Ma, Jixiang
Ma, Stefan
Machado, Vasco Manuel Pedro
Mainoo, Nana Kwaku
Majdan, Marek
Mapom, Christopher Chabila
Marcenes, Wagner
Marza, Melvin Barrientos
Mason-Jones, Amanda J.
Mehndiratta, Man Mohan
Mejia-Rodriguez, Fabiola
Memish, Ziad A.
Mendoza, Walter
Miller, Ted R.
Mills, Edward J.
Mokdad, Ali H.
Mola, Glen Liddell
Monasta, Lorenzo
de la Cruz Monis, Jonathan
Montañez Hernandez, Julio Cesar
Moore, Ami R.
Mori, Rintaro
Mueller, Ulrich O.
Mukaigawara, Mitsuru
Naheed, Aliya
Naidoo, Kovin S.
Nand, Devina
Nangia, Vinay
Nash, Denis
Nejjar, Chakib
Nelson, Robert G.
Neupane, Sudan Prasad
Newton, Charles R.
Ng, Marie
Nieuwenhuijsen, Mark J.
Nisar, Muhammad Imran
Nolte, Sandra
Norheim, Ole F.
Nyakarahuka, Luke
Oh, In-Hwan
Ohkubo, Takayoshi
Olusanya, Bolajoko O.
Omer, Saad B.
Opio, John Nelson
Orisakwe, Orish Ebere
Pandian, Jeyaraj D.
Papachristou, Christina
Park, Jae-Hyun
Paternina Caicedo, Angel J.
Patten, Scott B.
Pau, Vinod K.
Pavlin, Boris Igor
Pearce, Neil
Pereira, David M.
Pesudovs, Konrad
Petzold, Max
Poenaru, Dan
Polanczyk, Guilherme V.
Polind, Suzanne
Pope, Dan
Pourmalek, Farshad
Qato, Dima
Quistberg, D. Alex
Rafay, Anwar
Rahimi, Kazem
Rahimi-Movaghar, Vafa
Rahman, Sajjad ur
Raju, Murugesan
Rana, Saleem M.
Refaatk, Amany
Ronfani, Luca
Roy, Nobhojit
Sánchez Pimienta, Tania Georgina
Sahraian, Mohammad Ali
Salomon, Joshua
Sampson, Uchechukwu
Santos, Itamar S.
Sawhney, Monika
Sayinzoga, Felix
Schneider, Ione J. C.
Schumacher, Austin
Schwebel, David C.
Seedat, Soraya
Sepanlou, Sadaf G.
Servan-Mori, Edson E.
Shakh-Nazarova, Marina
Sheikhbahaei, Sara
Shibuya, Kenji
Shin, Hwashin Hyun
Shiue, Ivy
Sigfusdottir, Inga Dora
Silberberg, Donald H.
Silva, Andrea P.
Singh, Jasvinder A.
Skirbekk, Vegard
Sliwa, Karen
Soshnikov, Sergey S.
Sposato, Luciano A.
Sreeramareddy, Chandrashekhar T.
Stroumpoulis, Konstantinos
Sturua, Lela
Sykes, Bryan L.
Tabb, Karen M.
Talongwa, Roberto Tchio
Tan, Feng
Teixeira, Carolina Maria
Tenkorang, Eric Yeboah
Terkawi, Abdullah Sulieman
Thorne-Lyman, Andrew L.
Tirschwell, David L.
Towbin, Jeffrey A.
Tran, Bach X.
Tsilimbaris, Miltiadis
Uchendu, Uche S.
Ukwaja, Kingsley N.
Undurraga, Eduardo A.
Uzun, Selen Begüm
Vallely, Andrew J.
van Gool, Coen H.
Vasankari, Tommi J.
Vavilala, Monica S.
Venketasubramanian, N.
Villalpando, Salvador
Violante, Francesco S.
Vlassov, Vasiliy Victorovich
Vos, Theo
Waller, Stephen
Wang, Haidong
Wang, Linhong
Wang, Sharon XiaoRong
Wang, Yanping
Weichenthal, Scott
Weiderpass, Elisabete
Weintraub, Robert G.
Westerman, Ronny
Wilkinson, James D.
Woldeyohannes, Solomon Meseret
Wong, John Q.
Wordofa, Muluemebet Abera
Xu, Gelin
Yang, Yang C.
Yano, Yuichiro
Yentur, Gokalp Kadri
Yip, Paul
Yonemoto, Naohiro
Yoon, Seok-Jun
Younis, Mustafa Z.
Yu, Chuanhua
Jin, Kim Yun
Zak, Maysaa El Sayed
Zhao, Yong
Zheng, Yingfeng
Zhou, Maigeng
Zhu, Jun
Zou, Xiao Nong
Lopez, Alan D.
Naghavi, Mohsen
Murray, Christopher J. L.
Lozano, Rafael
Title Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Journal name The Lancet   Check publisher's open access policy
ISSN 0140-6736
1474-547X
Publication date 2014-05-02
Year available 2014
Sub-type Article (original research)
DOI 10.1016/S0140-6736(14)60696-6
Volume 384
Issue 9947
Start page 980
End page 1004
Total pages 25
Place of publication London, United Kingdom
Publisher The Lancet Publishing Group
Language eng
Formatted abstract
Background: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.

Methods: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990–2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.

Findings: 292 982 (95% UI 261 017–327 792) maternal deaths occurred in 2013, compared with 376 034 (343 483–407 574) in 1990. The global annual rate of change in the MMR was −0·3% (–1·1 to 0·6) from 1990 to 2003, and −2·7% (–3·9 to −1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290–2866) maternal deaths were related to HIV in 2013, 0·4% (0·2–0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1–1262·8) in South Sudan to 2·4 (1·6–3·6) in Iceland.

Interpretation: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. 
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online ahead of print 2 May 2014.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Public Health Publications
 
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Created: Tue, 27 May 2014, 22:18:50 EST by Hebe Gouda on behalf of School of Public Health