Maternal deaths worldwide could be reduced by 60,000 per year if women received appropriate HIV diagnosis and treatment, researchers report in an analysis of global progress towards Millenium Development Goal 5 – a 75% reduction in maternal mortality by 2015.
The analysis, published last week in The Lancet, also shows that only 23 countries are on course to achieve the goal. In sub-Saharan Africa maternal mortality rates increased by at least 1% per year in South Africa, Namibia, Mozambique, Lesotho, Swaziland, Botswana and Zimbabwe, driven largely by HIV-related deaths.
Worldwide, maternal deaths fell by around 180,000 between 1980 and 2008, from around 525,000 per year to 340,000 per year. Without HIV, maternal deaths would have been 60,000 fewer by 2008, the researchers estimate.
The overall global decline in maternal mortality was driven largely by a decline in India and China, the world’s most populous countries. In India the rate of maternal death has declined by an average of 4% per year since 1990. Other rapidly developing nations such as Brazil, Egypt and Turkey also experienced large declines in maternal mortality.
The analysis looked at census data, death registrations, surveys and verbal autopsy records for 181 countries between 1980 and 2008.
Discussing the lack of progress on maternal mortality in southern and eastern Africa, Dr Christopher Murray of the Institute of Health Metrics and Evaluation at the University of Washington told The New York Times:
“It means, to us, that if you want to tackle maternal mortality in those regions, you need to pay attention to the management of HIV in pregnant women. It’s not about emergency obstetrical care, but about access to antiretrovirals.”
Critics of spending on HIV programmes have cited spending on obstetrical care as one of the `quick wins` that would have greater impact on achievement of the Millenium Development Goals than spending on HIV testing and care for pregnant women.
“HIV services do not compete with other health priorities,” said Robin Gorna, executive director of the International AIDS Society. “They support them by reducing all-cause mortality; improving maternal health; improving child health by preventing and treating HIV disease in children and reducing diarrhoeal and other diseases through safe breastfeeding. This study reminds us that those who seek to pit maternal health against HIV in a competition for resources are deeply misguided."
Reference
Hogan MC et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millenium Development Goal 5. The Lancet, advance online publication, April 12, 2010.