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Setting a Target for M aternal Mortality

Setting a Target for M aternal Mortality. Marjorie Koblinsky, USAID Thomas Pullum , MEASURE DHS Tessa Wardlaw , Danzhen You, UNICEF Lale Say, Doris Chou (WHO) Sam Whipple (KMS) Sept 5, 2013 Original presentation condensed . 1. Setting a target for maternal mortality.

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Setting a Target for M aternal Mortality

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  1. Setting a Target for Maternal Mortality Marjorie Koblinsky, USAID Thomas Pullum, MEASURE DHS Tessa Wardlaw, Danzhen You, UNICEF Lale Say, Doris Chou (WHO) Sam Whipple (KMS) Sept 5, 2013 Original presentation condensed

  2. 1. Setting a target for maternal mortality Characteristics : ambitious but plausible; should accelerate progress Four key components to target setting: • End year: Focus here on 2035, but actual value is TBD (MDG 5: 1990-2015) • Indicator: MMR or # maternal deaths, LTR, other? (MDG 5: MMR) • Annual Rate of Reduction (ARR) does not have to be constant, but the average value should be feasible, aggressive (MDG 5: ARR of 5.5%) • End value: Determined by the choice of end year and ARR, with rounding (MDG 5: 25% of the start value, or a decline of 75%--a relative target—over 25 year period)

  3. 1. Indicator: Present MMR • Table 1: Number of Countries with specific ranges of MMR in 2010 (n=189) Global MMR: 210 maternal deaths per 100,000 live births in 2010 Globalnumber of maternal deaths: 287,000 in 2010 77 countries already reached an MMR of 50 or lower; among them, 58 already reached an MMR of 30 or lower 26 countries still had an MRR more than 400 deaths per 100,000 live births Statistics & Monitoring Section/DPS

  4. 2. Absolute Target: Historical trends and projections, MMR = 50 by 2035, worldwide

  5. 2. Absolute Target: Historical trends and projections MMR = 50 by 2035, regions 225 50 Asia: Afghanistan, Bhutan, Cambodia, Indonesia, Iran, Iraq, Kyrgyzstan, Lao, Morocco, Myanmar, Nepal, Pakistan, Papua New Guinea, Philippines, Solomon Islands, Tajikistan, Turkmenistan, Uzbekistan, VietNam, Yemen Africa: Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo, Cote d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Togo, Uganda, Tanzania, Zambia, Zimbabwe

  6. 2. Absolute target: Annual rates of reduction (ARR) • Global ARR: 3.1% in 1990-2010; 4.1% in 2000-2010 • Only 20 countries had an ARR more than 6%; among them, only 5 countries had an ARR more than 8% • Plausible ARR range: 5-7% Table 2: Number of Countries with specific ranges of ARR in 2000-2010 Statistics & Monitoring Section/DPS

  7. 2. Absolute target: Afghanistan, Bangladesh, Nepal, Pakistan 50 Source: UN Estimates for Trends in Maternal Mortality 1990-2010.World Health Organization, 2012.

  8. 3. Relative Target: 2010 and 2035 MMR Estimates (85% Reduction; ARR=7.3%) 2010 Estimate 2035 Target MMR<100 100≤MMR<200 200≤MMR<400 MMR≥400 MMR<15 15≤MMR<30 30≤MMR<60 MMR≥60

  9. 2. Absolute target: Countries Require Different Annual Rates of Reduction to Achieve MMR=50 by 2035 Required ARR to Reach MMR=50 Already achieved MMR≤50 0≤ARR<4% 4%≤ARR<8% ARR≥8%

  10. 3. Relative Target: MCH Priority Countries with 2035 Projection (85% Reduction, ARR=7.3%) • Afghanistan*: 46069 • Angola: 45068 • Bangladesh*: 24036 • Burundi: 800120 • Cameroon: 690104 • Central African Republic: 890134 • Chad: 1100165 • Congo: 56084 • DRC*: 54081 • Ethiopia*: 35053 • Ghana: 35053 • Guinea: 61092 • Guinea-Bissau: 790119 • Haiti*: 35053 • India*: 20030 • Indonesia*: 22033 • Ivory Coast*: 40060 • Kenya*: 36054 • Laos: 47071 • Lesotho: 62093 • Liberia*: 770116 • Madagascar*: 24036 • Malawi*: 46069 • Mali*: 54081 • Mauritania: 51077 • Mozambique*: 49074 • Nepal*: 17026 • Niger: 59089 • Nigeria*: 63095 • Pakistan*: 26039 • Rwanda*: 34051 • Senegal*: 37056 • Sierra Leone: 890134 • Somalia: 1000150 • Sudan*: 730110 • Tanzania*: 46069 • Uganda*: 31047 • Yemen*: 20030 • Zambia*: 44066 • Zimbabwe*: 57086 Source: UN Estimates for Trends in Maternal Mortality 1990-2010.World Health Organization, 2012. * MCH Priority Country

  11. 4. Key points and questions • Indicator: Should we continue with the MMR? • Absolute Targetdepends on current MMR, end year • Does a GLOBAL indicator make sense? Absolute country targets make achieving goals difficult for high MMR countries, particularly sub-Saharan African countries. • ARR trajectory: Depends on country’s current MMR • Should high MMR countries aim for higher MMR in 2035 (MMR=100)? • Should low MMR countries focus on equity (high MMR subpopulations)? • Should we set 5 year milestones? • Plausible Relative Target will depend on the end year • 2035: 80% decline, global MMR target=50 • 2030: 70% decline, global MMR target=60 • 2025: 60% decline, global MMR target=80 or 90

  12. Setting a Target for Maternal MortalityIn LAC Peg Marshall, USAID Kelsey Wright(KMS) November 14, 2013

  13. Trends shown in these slides include:-Projections to 2035 using current ARR-Projections to 2035 using goal of MMR=50 by 2035-Projections to 2035 using goal of 50% reduction in MMR-Projections to 2035 using goal of 75% reduction in MMR Current ARRs are based on 1990-2010 estimates Regional Averages are weighted by live births from 1990-2010

  14. Weighted Regional Projections

  15. Weighted Average of Selected LAC Countries* *Countries included in weighted analysis are: Bolivia, Brazil, Canada, Colombia, Costa Rica, Dominican Republic, Guatemala, Guyana, Haiti, Jamaica, Paraguay, United States Sources: (1) MMR data from WHO (2012). Trends in Maternal Mortality: 1990 to 2010; (2) Live births data from U.S. Census Bureau International Data Base; (3) Census Bureau Table of Live Births 1909-2003 (http://www.cdc.gov/nchs/data/statab/natfinal2003.annvol1_01.pdf)

  16. Select LAC Countries where Current MMR ARR is Positive (MMR is increasing)

  17. Positive MMR ARRs in the LAC Region Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  18. Positive MMR ARRs in the LAC Region Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  19. Canada MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  20. Costa Rica MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  21. Guyana MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  22. Jamaica MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  23. U.S. MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  24. Select LAC Countries where 50% Reduction by 2035 is equal to or below MMR=50

  25. 50% Reduction by 2035 is ≤MMR=50 ARR 2035 MMR Current -1.0 78 MMR=50 -2.7 50 50% Reduction -2.7 50 75% Reduction -5.4 25 Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  26. Brazil MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  27. Colombia MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  28. Paraguay MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  29. Select LAC Countries where 75% Reduction by 2035 is equal to or below MMR=50

  30. 75% Reduction by 2035 is ≤MMR=50 ARR 2035 MMR Current -1.4 84 MMR=50 -3.4 50 50% Reduction -2.7 60 75% Reduction -5.4 30 Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  31. Bolivia MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  32. Dominican Republic MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  33. Guatemala MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  34. Select LAC countries where no projections for 2035 are below MMR=50

  35. Haiti MMR Projections Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  36. 2010 Maternal Mortality Ratio (MMR) in Selected LAC Countries Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  37. 2035 Projected Maternal Mortality Ratio (MMR) in Selected LAC Countries (Current ARR) Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  38. 2035 Projected Maternal Mortality Ratio (MMR) in Selected LAC Countries (ARR to reach 50% reduction in MMR) Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  39. 2035 Projected Maternal Mortality Ratio (MMR) in Selected LAC Countries (ARR to reach 75% reduction in MMR) Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  40. 2010 MMR Estimates vs. 2035 MMR Projections in Selected LAC Countries 2010 MMR Estimates 2035 MMR Projections (Current ARR) Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  41. 2035 MMR Projections in Selected LAC Countries: 50% vs. 75% reduction 2035 MMR Projections (ARR to reach 75% Reduction) 2035 MMR Projections (ARR to reach 50% Reduction) Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  42. 2010 ARR in Selected LAC Countries Source: Trends in maternal mortality: 1990 to 2010. WHO, UNICEF, UNFPA and The World Bank estimates. World Health Organization, 2012.

  43. Our recommendations for future targets which include the diversity and special needs of the region are???

  44. Thank you!

  45. 2. Absolute target: Sri Lanka & Thailand Source: UN Estimates for Trends in Maternal Mortality 1990-2010.World Health Organization, 2012.

  46. 3. Relative Target: 2010 and 2035 MMR Estimates (75% Reduction; ARR=5.5%) 2010 Estimate 2035 Target MMR<100 100≤MMR<200 200≤MMR<400 MMR≥400 MMR<25 25≤MMR<50 50≤MMR<100 MMR≥100

  47. 3. Relative target for MMR: Bangladesh & Nepal--75% and 85% Source: UN Estimates for Trends in Maternal Mortality 1990-2010.World Health Organization, 2012.

  48. 3. Relative target for MMR: China & Sri Lanka --75% and 85% Source: UN Estimates for Trends in Maternal Mortality 1990-2010.World Health Organization, 2012.

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