New Findings for Maternal Mortality Age Patterns: Aggregated Results for 38 Countries

Abstract

BackgroundWith recent results showing a global decline in overall maternal mortality during the last two decades and with the target date for achieving the Millennium Development Goals only four years away, the question of how to continue or even accelerate the decline has become more pressing. By knowing where the risk is highest as well as where the numbers of deaths are greatest, it may be possible to re-direct resources and fine-tune strategies for greater effectiveness in efforts to reduce maternal mortality.MethodsWe aggregate data from 38 Demographic and Health Surveys that included a maternal mortality module and were conducted in 2000 or later to produce maternal mortality ratios, rates, and numbers of deaths by five year age groups, separately by residence, region, and overall mortality level.FindingsThe age pattern of maternal mortality is broadly similar across regions, type of place of residence, and overall level of maternal mortality. A “J” shaped curve, with markedly higher risk after age 30, is evident in all groups. We find that the excess risk among adolescents is of a much lower magnitude than is generally assumed. The oldest age groups appear to be especially resistant to change. We also find evidence of extremely elevated risk among older mothers in countries with high levels of HIV prevalence.ConclusionsThe largest number of deaths occurs in the age groups from 20-34, largely because those are the ages at which women are most likely to give birth so efforts directed at this group would most effectively reduce the number of deaths. Yet equity considerations suggest that efforts also be directed toward those most at risk, i.e., older women and adolescents. Because women are at risk each time they become pregnant, fulfilling the substantial unmet need for contraception is a cross-cutting strategy that can address both effectiveness and equity concerns.

The Effects of Maternal Mortality on Infant and Child Survival in Rural Tanzania: A Cohort Study

“…We test whether the fraction of women in each category are the same for the two groups of women: women who die and women who survive. Women who experienced a maternal death, particularly shortly after birth (42-day window) were more commonly adolescents than their surviving counterparts (p = 0.01), which corresponds to a period of known higher maternal mortality risk [25]. There was not a strong correlation between household wealth and maternal death, and the fraction poorest and richest within the two groups of women were not statistically different (p value = 0.968 for Matern Child Health J 123 poorest, 0.16 for richest).…”

Trends in the age at reproductive transitions in the developing world: The role of education

“…On average, the younger the age of a woman at marriage, the larger the age difference between spouses, the less agency women are reported to have within marriage, and the higher the likelihood of marital dissolution (Singh and Samara 1996;Mensch 2005). And finally, early childbirth, before achieving full physical maturity around age 16, is associated with a higher likelihood of maternal death (Blanc et al 2013;Nove et al 2014), infant death, and other poor child health outcomes (Finlay et al 2011). Moreover, the timing of births has an effect on population growth.…”

A dynamic framework for the study of optimal birth intervals reveals the importance of sibling competition and mortality risks

“…However, there are considerable risks associated with reproduction both for the mother and her existing family. First, the mother is exposed to the risks associated with childbirth, which increase with age (Grimes, 1994;Blanc et al, 2013). Second, offspring spaced too closely encounter competition for maternal provisions; for example, the youngest child must be weaned before the next is born.…”

“…Parameters for the J-shaped function were calculated from data presented in Blanc et al (2013) fitted to a second-degree polynomial; the exponential function was fitted to data in Grimes (1994). See Table S2 for parameter values and Fig.…”

“…1 (a) Age-specific mortality risk in each of the five modelled populations: Ache (gray), Gambia (orange), Sweden (blue), Taiwan (green) and Tsimane (yellow) from birth until a maximum lifespan of 90 (although note that reproductive spans last until age 50). (b) Maternal mortality hazards during the reproductive span (ages 15-50): solid lines show fitted probability functions for a J-shaped mortality function derived from Blanc et al (2013) with three levels: low (blue), medium (vermilion) and high (yellow). Dashed lines show an exponential maternal mortality function derived from Grimes (1994) with three levels: low (orange), medium (sky blue) and high (gray).…”