Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

N. J. Kassebaum, R. M. Barber, L. Dandona, S. I. Hay, H. J. Larson, S. S. Lim, A. D. Lopez, A. H. Mokdad, M. Naghavi, C. Pinho, C. Steiner, T. Vos, H. Wang, T. Achoki, G. M. Anderson, M. Arora, S. Biryukov, J. D. Blore, A. Carter, D. C. CaseyM. M. Coates, M. Coggeshall, D. J. Dicker, E. Dossou, T. Fleming, M. S. Fraser, J. Friedman, N. Fullman, N. Graetz, J. Hancock, C. Huynh, M. Iannarone, L. Kemmer, X. R. Kulikoff, M. J. Kutz, P. Y. Liu, N. Marquez, A. Misganaw, M. D. Mooney, M. Moradi-Lakeh, M. Ng, G. Nguyen, A. Pain, K. A. Shackelford, N. Silpakit, A. Sligar, J. M. Smith, R. J.D. Sorensen, S. E. Vollset, J. A. Wagner, T. Wolock, Y. Zhao, M. Zhou, C. J.L. Murray, B. E. Ebel, N. D. Futran, K. M. Harun, Z. A. Bhutta, M. I. Nisar, N. Akseer, Z. A. Bhutta, P. Jeemon, L. Dandona, R. Dandona, S. Goenka, G. A. Kumar, P. W. Gething, D. Bisanzio, A. Deribew, C. Cooper, S. I. Hay, R. Ali, D. A. Bennett, V. Jha, K. Rahimi, Y. Kinfu, H. J. Larson, G. V.S. Murthy, Y. Li, S. Liu, L. Wang, M. Zhou, X. Liang, S. Yu, A. D. Lopez, P. Azzopardi, K. B. Gibney, A. Meretoja, C. E.I. Szoeke, P. Azzopardi, K. Alam, S. M. Colquhoun, R. G. Weintraub, K. Alam, S. M. Colquhoun, T. Wijeratne, R. Lozano, I. R. Campos-Nonato, J. C. Campuzano, H. Gomez-Dantes, H. Lamadrid-Figueroa, F. Mejia-Rodriguez, J. C. Montañez Hernandez, P. Montero, G. A. Mensah, J. A. Salomon, A. L. Thorne-Lyman, O. N. Ajala, T. Bärnighausen, I. R. Campos-Nonato, E. L. Ding, M. S. Farvid, J. R.A. Fitchett, A. A. Abajobir, L. D. Knibbs, R. Lalloo, N. K.M. Alam, Y. Guo, K. H. Abate, T. T. Gebrehiwot, A. T. Gebremedhin, K. M. Abbas, F. Abd-Allah, M. A. Abdallat, A. M. Abdulle, S. F. Abera, Y. A. Melaku, F. H. Tesfay, A. F. Aregay, T. A. Bayou, B. D. Betsu, M. Gebremedhin, A. A. Gebru, G. B. Hailu, T. Tekle, A. Z. Yalew, H. G. Yebyo, S. F. Abera, S. F. Abera, V. Aboyans, I. Abubakar, R. W. Aldridge, A. Banerjee, N. M. Aburmeileh, A. O. Adebiyi, A. L. Adelekan, F. A. Ojelabi, A. O. Adebiyi, I. A. Adedeji, A. L. Adelekan, A. K. Adou, K. A. Afanvi, K. A. Afanvi, N. Akseer, A. Badawi, A. Agarwal, A. Agarwal, A. Ahmad Kiadaliri, A. Ahmad Kiadaliri, O. N. Ajala, T. F. Akinyemiju, D. C. Schwebel, J. A. Singh, Z. Al-Aly, K. Alam, A. H. Kemp, J. Leigh, A. B. Mekonnen, N. K.M. Alam, D. Alasfoor, S. F. Aldhahri, A. S. Terkawi, S. F. Aldhahri, S. Alhabib, A. Alkerwi, F. Alla, R. Al-Raddadi, U. Alsharif, E. Alvarez Martin, N. Alvis-Guzman, A. T. Amare, Y. A. Melaku, L. G. Ciobanu, G. A. Tessema, A. T. Amare, T. Setegn, A. Amberbir, A. K. Amegah, A. A. Kudom, W. Ammar, H. L. Harb, S. M. Amrock, H. H. Andersen, R. M. Antoine, C. A.T. Antonio, E. J.A. Faraon, J. Ärnlöv, A. Larsson, J. Ärnlöv, V. S. Arsic Arsenijevic, A. Barac, V. S. Arsic Arsenijevic, A. Artaman, H. Asayesh, S. Atique, E. F.G.A. Avokpaho, E. F.G.A. Avokpaho, A. Awasthi, B. P. Ayala Quintanilla, B. P. Ayala Quintanilla, P. Azzopardi, U. Bacha, A. Badawi, M. C. Bahit, K. Balakrishnan, S. L. Barker-Collo, T. Bärnighausen, T. Bärnighausen, S. Mohammed, S. Basu, Y. T. Bayou, S. Bazargan-Hejazi, S. Bazargan-Hejazi, S. Bazargan-Hejazi, J. Beardsley, N. Bedi, T. Bekele, M. L. Bell, B. J. Biroscak, J. J. Huang, I. S. Santos, I. M. Bensenor, P. A. Lotufo, A. Berhane, C. D. Wolfe, E. Bernabé, A. S. Beyene, S. Biadgilign, B. Bikbov, Leslie T Jr. Cooper, B. J. Biroscak, E. Bjertness, A. S. Htet, M. Brainin, A. Brazinova, M. Majdan, A. Brazinova, J. Shen, N. J.K. Breitborde, T. S. Brugha, Z. A. Butt, R. Cárdenas, S. Fereshtehnejad, M. Kivipelto, E. Weiderpass, R. Havmoeller, S. Sindi, C. A. Castañeda-Orjuela, C. A. Castañedaorjuela, R. E. Castro, F. Catalá-López, F. Catalá-López, F. Cavalleri, V. Colistro, H. Chang, H. Chang, J. Chang, L. Chavan, C. E. Chibueze, V. H. Chisumpa, C. C. Mapoma, F. Masiye, V. H. Chisumpa, J. J. Choi, R. Chowdhury, D. J. Christopher, M. Cirillo, V. Colistro, C. Cooper, C. Cooper, L. T. Cooper, T. Dahiru, A. Damasceno, H. Danawi, A. H. Refaat, J. Das Neves, J. V. Santos, D. De Leo, R. P. Dellavalle, K. Deribe, K. Deribe, A. D. Hailu, W. Tefera, A. Z. Giref, T. Jibat, G. Temam Shifa, A. Deribew, D. C. Des Jarlais, D. C. Des Jarlais, S. D. Dharmaratne, M. Dubey, M. H.U. Rahman, U. Ram, A. Singh, A. K. Yadav, S. E. Vollset, C. L. Ellingsen, M. Savic, V. Skirbekk, I. Elyazar, S. P. Ermakov, S. P. Ermakov, S. Soshnikov, B. Eshrati, B. Eshrati, F. Farzadfar, A. Kasaeian, F. Pishgar, A. Esteghamati, N. Hafezi-Nejad, S. Sheikhbahaei, A. Kasaeian, A. Khosravi, R. Malekzadeh, G. Roshandel, S. G. Sepanlou, F. Pishgar, V. Rahimi-Movaghar, E. J.A. Faraon, T. A. Farid, A. R. Khan, C. S.E.S. Farinha, C. S.E.S. Farinha, A. Faro, M. S. Farvid, J. C. Fernandes, F. Fischer, N. Foigt, E. B. Franca, R. C. Franklin, T. Fürst, A. Majeed, T. Fürst, T. Fürst, K. Gambashidze, K. Kazanjan, M. Kereselidze, I. Khonelidze, M. Shakh-Nazarova, L. Sturua, A. Gamkrelidze, T. Gebre, A. T. Gebremedhin, A. A. Gebru, G. B. Hailu, J. M. Geleijnse, T. Jibat, K. B. Gibney, M. Giroud, M. D. Gishu, A. K. Tura, M. D. Gishu, E. Glaser, P. Gona, A. Goodridge, S. V. Gopalani, A. Goto, H. C. Gugnani, R. Gupta, R. Gupta, V. Gupta, S. E. Vollset, A. D. Hailu, O. F. Norheim, R. R. Hamadeh, S. Hamidi, A. J. Handal, G. J. Hankey, G. J. Hankey, G. J. Hankey, S. Harikrishnan, K. M. Harun, H. W. Hoek, A. K. Tura, H. W. Hoek, V. Skirbekk, M. Horino, M. Horino, N. Horita, H. D. Hosgood, D. G. Hoy, A. S. Htet, G. Hu, H. Huang, I. Huybrechts, I. Huybrechts, K. M. Iburg, B. T. Idrisov, B. T. Idrisov, V. J. Iyer, K. H. Jacobsen, N. Jahanmehr, M. B. Jakovljevic, M. Javanbakht, A. U. Jayatilleke, A. U. Jayatilleke, S. H. Jee, P. Jeemon, P. Jeemon, D. K. Lal, S. Zodpey, V. Jha, G. Jiang, Y. Jiang, J. B. Jonas, Z. Kabir, R. Kamal, C. N. Kesavachandran, J. She, H. Kan, A. Karch, A. Karch, D. Karletsos, A. Kaul, N. Kawakami, K. Shibuya, J. F. Kayibanda, D. S. Kazi, P. N. Keiyoro, P. N. Keiyoro, A. H. Kemp, A. P. Kengne, C. S. Wiysonge, K. Sliwa, A. P. Kengne, A. Keren, Y. S. Khader, E. A. Khan, Y. H. Khang, S. Won, A. Khosravi, J. Khubchandani, Y. J. Kim, Y. Kokubo, S. Kosen, P. A. Koul, A. Koyanagi, S. Krishnaswami, B. Kuate Defo, B. Kuate Defo, B. Kucuk Bicer, H. Lam, Q. Lan, D. O. Laryea, R. Leung, Y. Li, S. E. Lipshultz, J. D. Wilkinson, S. E. Lipshultz, E. P. Simard, Y. Liu, M. R. Phillips, Q. Xiao, B. K. Lloyd, B. K. Lloyd, R. Lunevicius, R. Lunevicius, D. Pope, S. Ma, S. Ma, H. Magdy Abd El Razek, M. Magdy Abd El Razek, W. Marcenes, P. A. Meaney, D. J. Margolis, M. B. Marzan, A. J. Mason-Jones, T. T. Mazorodze, P. A. Meaney, A. Mehari, M. M. Mehndiratta, S. M. Woldeyohannes, A. B. Mekonnen, B. A. Tedla, G. A. Tessema, Z. A. Memish, Z. A. Memish, W. Mendoza, A. Meretoja, T. J. Meretoja, T. J. Meretoja, F. A. Mhimbira, T. R. Miller, T. R. Miller, E. J. Mills, N. Mohamed Ibrahim, K. A. Mohammad, A. Mohammadi, S. Mohammed, G. L.D. Mola, L. Monasta, M. Montico, L. Ronfani, J. D. Monis, A. R. Moore, M. Moradilakeh, L. Morawska, R. E. Norman, R. Mori, A. Werdecker, U. O. Mueller, R. Westerman, G. V.S. Murthy, D. K. Lal, S. Zodpey, S. Murthy, F. Pourmalek, J. B. Nachega, A. J. Paternina Caicedo, J. B. Nachega, S. Seedat, C. S. Wiysonge, J. B. Nachega, B. X. Tran, A. Naheed, L. Naldi, G. Remuzzi, D. Nand, V. Nangia, D. Nash, S. Neupane, J. N. Newton, F. N. Ngalesoni, P. Nguhiu, Q. L. Nguyen, M. Nomura, L. Nyakarahuka, C. M. Obermeyer, F. A. Ogbo, I. Oh, P. R. Olivares, B. O. Olusanya, J. O. Olusanya, J. N. Opio, E. Oren, E. Ota, A. S. Oyekale, P. A. Mahesh, N. Papantoniou, V. Stathopoulou, E. Park, H. Park, A. J. Paternina Caicedo, S. B. Patten, V. K. Paul, A. Roy, R. Sagar, M. Satpathy, D. M. Pereira, M. Cortinovis, N. Perico, G. Remuzzi, K. Pesudovs, F. H. Tesfay, M. Petzold, M. Petzold, M. R. Phillips, J. D. Pillay, S. Polinder, M. Qorbani, A. Rafay, M. Rahman, S. U. Rahman, R. K. Rai, C. L. Ranabhat, T. Rangaswamy, P. V. Rao, P. V. Rao, A. H. Refaat, G. Remuzzi, S. Resnikoff, D. Rojas-Rueda, G. Roshandel, G. M. Ruhago, B. F. Sunguya, M. M. Saleh, J. R. Sanabria, J. R. Sanabria, M. D. Sanchez-Niño, R. Sarmiento-Suarez, B. Sartorius, M. Sawhney, M. I. Saylan, I. J.C. Schneider, D. A.S. Silva, E. E. Servan-Mori, M. A. Shaikh, R. Sharma, J. Shen, M. Shin, S. Yoon, R. Shiri, K. Shishani, I. Shiue, I. Shiue, I. D. Sigfusdottir, D. G.A. Silveira, J. I. Silverberg, Y. Yano, O. P. Singh, P. K. Singh, V. Singh, S. Soneji, J. B. Soriano, L. A. Sposato, C. T. Sreeramareddy, K. Stroumpoulis, K. Stroumpoulis, S. Swaminathan, B. L. Sykes, R. Tabarés-Seisdedos, K. M. Tabb, R. T. Talongwa, M. Tavakkoli, B. Taye, B. A. Tedla, A. Y. Endries, G. Temam Shifa, A. S. Terkawi, A. S. Terkawi, A. J. Thomson, A. L. Thorne-Lyman, R. Tobe-Gai, R. Topor-Madry, R. Topor-Madry, J. A. Towbin, J. A. Towbin, J. A. Towbin, B. X. Tran, Z. Tsala Dimbuene, S. Tyrovolas, K. N. Ukwaja, O. A. Uthman, T. Vasankari, N. Venketasubramanian, F. S. Violante, S. K. Vladimirov, V. V. Vlassov, S. Weichenthal, E. Weiderpass, E. Weiderpass, E. Weiderpass, R. G. Weintraub, R. Westerman, T. Wijeratne, J. D. Wilkinson, C. D. Wolfe, M. Wubshet, G. Xu, B. Yakob, H. G. Yebyo, P. Yip, N. Yonemoto, M. Z. Younis, C. Yu, Z. Zaidi, M. E. Zaki, H. Zeeb, Y. Zhao, L. J. Zuhlke

Research output: Contribution to journalArticle

211 Citations (Scopus)

Abstract

Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.

Original languageEnglish (US)
Pages (from-to)1775-1812
Number of pages38
JournalThe Lancet
Volume388
Issue number10053
DOIs
StatePublished - Oct 8 2016

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Maternal Mortality
Maternal Death
Demography
Reproductive Health
Prenatal Care
Fertility
Cause of Death
Health
Reproductive Health Services
Mothers
Delivery of Health Care
Global Burden of Disease
Ectopic Pregnancy
Information Storage and Retrieval
Conservation of Natural Resources
Family Planning Services
Spontaneous Abortion
Contraception
Information Systems
Obstetrics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kassebaum, N. J., Barber, R. M., Dandona, L., Hay, S. I., Larson, H. J., Lim, S. S., ... Zuhlke, L. J. (2016). Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1775-1812. https://doi.org/10.1016/S0140-6736(16)31470-2

Global, regional, and national levels of maternal mortality, 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015. / Kassebaum, N. J.; Barber, R. M.; Dandona, L.; Hay, S. I.; Larson, H. J.; Lim, S. S.; Lopez, A. D.; Mokdad, A. H.; Naghavi, M.; Pinho, C.; Steiner, C.; Vos, T.; Wang, H.; Achoki, T.; Anderson, G. M.; Arora, M.; Biryukov, S.; Blore, J. D.; Carter, A.; Casey, D. C.; Coates, M. M.; Coggeshall, M.; Dicker, D. J.; Dossou, E.; Fleming, T.; Fraser, M. S.; Friedman, J.; Fullman, N.; Graetz, N.; Hancock, J.; Huynh, C.; Iannarone, M.; Kemmer, L.; Kulikoff, X. R.; Kutz, M. J.; Liu, P. Y.; Marquez, N.; Misganaw, A.; Mooney, M. D.; Moradi-Lakeh, M.; Ng, M.; Nguyen, G.; Pain, A.; Shackelford, K. A.; Silpakit, N.; Sligar, A.; Smith, J. M.; Sorensen, R. J.D.; Vollset, S. E.; Wagner, J. A.; Wolock, T.; Zhao, Y.; Zhou, M.; Murray, C. J.L.; Ebel, B. E.; Futran, N. D.; Harun, K. M.; Bhutta, Z. A.; Nisar, M. I.; Akseer, N.; Bhutta, Z. A.; Jeemon, P.; Dandona, L.; Dandona, R.; Goenka, S.; Kumar, G. A.; Gething, P. W.; Bisanzio, D.; Deribew, A.; Cooper, C.; Hay, S. I.; Ali, R.; Bennett, D. A.; Jha, V.; Rahimi, K.; Kinfu, Y.; Larson, H. J.; Murthy, G. V.S.; Li, Y.; Liu, S.; Wang, L.; Zhou, M.; Liang, X.; Yu, S.; Lopez, A. D.; Azzopardi, P.; Gibney, K. B.; Meretoja, A.; Szoeke, C. E.I.; Azzopardi, P.; Alam, K.; Colquhoun, S. M.; Weintraub, R. G.; Alam, K.; Colquhoun, S. M.; Wijeratne, T.; Lozano, R.; Campos-Nonato, I. R.; Campuzano, J. C.; Gomez-Dantes, H.; Lamadrid-Figueroa, H.; Mejia-Rodriguez, F.; Montañez Hernandez, J. C.; Montero, P.; Mensah, G. A.; Salomon, J. A.; Thorne-Lyman, A. L.; Ajala, O. N.; Bärnighausen, T.; Campos-Nonato, I. R.; Ding, E. L.; Farvid, M. S.; Fitchett, J. R.A.; Abajobir, A. A.; Knibbs, L. D.; Lalloo, R.; Alam, N. K.M.; Guo, Y.; Abate, K. H.; Gebrehiwot, T. T.; Gebremedhin, A. T.; Abbas, K. M.; Abd-Allah, F.; Abdallat, M. A.; Abdulle, A. M.; Abera, S. F.; Melaku, Y. A.; Tesfay, F. H.; Aregay, A. F.; Bayou, T. A.; Betsu, B. D.; Gebremedhin, M.; Gebru, A. A.; Hailu, G. B.; Tekle, T.; Yalew, A. Z.; Yebyo, H. G.; Abera, S. F.; Abera, S. F.; Aboyans, V.; Abubakar, I.; Aldridge, R. W.; Banerjee, A.; Aburmeileh, N. M.; Adebiyi, A. O.; Adelekan, A. L.; Ojelabi, F. A.; Adebiyi, A. O.; Adedeji, I. A.; Adelekan, A. L.; Adou, A. K.; Afanvi, K. A.; Afanvi, K. A.; Akseer, N.; Badawi, A.; Agarwal, A.; Agarwal, A.; Kiadaliri, A. Ahmad; Kiadaliri, A. Ahmad; Ajala, O. N.; Akinyemiju, T. F.; Schwebel, D. C.; Singh, J. A.; Al-Aly, Z.; Alam, K.; Kemp, A. H.; Leigh, J.; Mekonnen, A. B.; Alam, N. K.M.; Alasfoor, D.; Aldhahri, S. F.; Terkawi, A. S.; Aldhahri, S. F.; Alhabib, S.; Alkerwi, A.; Alla, F.; Al-Raddadi, R.; Alsharif, U.; Martin, E. Alvarez; Alvis-Guzman, N.; Amare, A. T.; Melaku, Y. A.; Ciobanu, L. G.; Tessema, G. A.; Amare, A. T.; Setegn, T.; Amberbir, A.; Amegah, A. K.; Kudom, A. A.; Ammar, W.; Harb, H. L.; Amrock, S. M.; Andersen, H. H.; Antoine, R. M.; Antonio, C. A.T.; Faraon, E. J.A.; Ärnlöv, J.; Larsson, A.; Ärnlöv, J.; Arsic Arsenijevic, V. S.; Barac, A.; Arsic Arsenijevic, V. S.; Artaman, A.; Asayesh, H.; Atique, S.; Avokpaho, E. F.G.A.; Avokpaho, E. F.G.A.; Awasthi, A.; Ayala Quintanilla, B. P.; Ayala Quintanilla, B. P.; Azzopardi, P.; Bacha, U.; Badawi, A.; Bahit, M. C.; Balakrishnan, K.; Barker-Collo, S. L.; Bärnighausen, T.; Bärnighausen, T.; Mohammed, S.; Basu, S.; Bayou, Y. T.; Bazargan-Hejazi, S.; Bazargan-Hejazi, S.; Bazargan-Hejazi, S.; Beardsley, J.; Bedi, N.; Bekele, T.; Bell, M. L.; Biroscak, B. J.; Huang, J. J.; Santos, I. S.; Bensenor, I. M.; Lotufo, P. A.; Berhane, A.; Wolfe, C. D.; Bernabé, E.; Beyene, A. S.; Biadgilign, S.; Bikbov, B.; Cooper, Leslie T Jr.; Biroscak, B. J.; Bjertness, E.; Htet, A. S.; Brainin, M.; Brazinova, A.; Majdan, M.; Brazinova, A.; Shen, J.; Breitborde, N. J.K.; Brugha, T. S.; Butt, Z. A.; Cárdenas, R.; Fereshtehnejad, S.; Kivipelto, M.; Weiderpass, E.; Havmoeller, R.; Sindi, S.; Castañeda-Orjuela, C. A.; Castañedaorjuela, C. A.; Castro, R. E.; Catalá-López, F.; Catalá-López, F.; Cavalleri, F.; Colistro, V.; Chang, H.; Chang, H.; Chang, J.; Chavan, L.; Chibueze, C. E.; Chisumpa, V. H.; Mapoma, C. C.; Masiye, F.; Chisumpa, V. H.; Choi, J. J.; Chowdhury, R.; Christopher, D. J.; Cirillo, M.; Colistro, V.; Cooper, C.; Cooper, C.; Cooper, L. T.; Dahiru, T.; Damasceno, A.; Danawi, H.; Refaat, A. H.; Neves, J. Das; Santos, J. V.; De Leo, D.; Dellavalle, R. P.; Deribe, K.; Deribe, K.; Hailu, A. D.; Tefera, W.; Giref, A. Z.; Jibat, T.; Shifa, G. Temam; Deribew, A.; Des Jarlais, D. C.; Des Jarlais, D. C.; Dharmaratne, S. D.; Dubey, M.; Rahman, M. H.U.; Ram, U.; Singh, A.; Yadav, A. K.; Vollset, S. E.; Ellingsen, C. L.; Savic, M.; Skirbekk, V.; Elyazar, I.; Ermakov, S. P.; Ermakov, S. P.; Soshnikov, S.; Eshrati, B.; Eshrati, B.; Farzadfar, F.; Kasaeian, A.; Pishgar, F.; Esteghamati, A.; Hafezi-Nejad, N.; Sheikhbahaei, S.; Kasaeian, A.; Khosravi, A.; Malekzadeh, R.; Roshandel, G.; Sepanlou, S. G.; Pishgar, F.; Rahimi-Movaghar, V.; Faraon, E. J.A.; Farid, T. A.; Khan, A. R.; Farinha, C. S.E.S.; Farinha, C. S.E.S.; Faro, A.; Farvid, M. S.; Fernandes, J. C.; Fischer, F.; Foigt, N.; Franca, E. B.; Franklin, R. C.; Fürst, T.; Majeed, A.; Fürst, T.; Fürst, T.; Gambashidze, K.; Kazanjan, K.; Kereselidze, M.; Khonelidze, I.; Shakh-Nazarova, M.; Sturua, L.; Gamkrelidze, A.; Gebre, T.; Gebremedhin, A. T.; Gebru, A. A.; Hailu, G. B.; Geleijnse, J. M.; Jibat, T.; Gibney, K. B.; Giroud, M.; Gishu, M. D.; Tura, A. K.; Gishu, M. D.; Glaser, E.; Gona, P.; Goodridge, A.; Gopalani, S. V.; Goto, A.; Gugnani, H. C.; Gupta, R.; Gupta, R.; Gupta, V.; Vollset, S. E.; Hailu, A. D.; Norheim, O. F.; Hamadeh, R. R.; Hamidi, S.; Handal, A. J.; Hankey, G. J.; Hankey, G. J.; Hankey, G. J.; Harikrishnan, S.; Harun, K. M.; Hoek, H. W.; Tura, A. K.; Hoek, H. W.; Skirbekk, V.; Horino, M.; Horino, M.; Horita, N.; Hosgood, H. D.; Hoy, D. G.; Htet, A. S.; Hu, G.; Huang, H.; Huybrechts, I.; Huybrechts, I.; Iburg, K. M.; Idrisov, B. T.; Idrisov, B. T.; Iyer, V. J.; Jacobsen, K. H.; Jahanmehr, N.; Jakovljevic, M. B.; Javanbakht, M.; Jayatilleke, A. U.; Jayatilleke, A. U.; Jee, S. H.; Jeemon, P.; Jeemon, P.; Lal, D. K.; Zodpey, S.; Jha, V.; Jiang, G.; Jiang, Y.; Jonas, J. B.; Kabir, Z.; Kamal, R.; Kesavachandran, C. N.; She, J.; Kan, H.; Karch, A.; Karch, A.; Karletsos, D.; Kaul, A.; Kawakami, N.; Shibuya, K.; Kayibanda, J. F.; Kazi, D. S.; Keiyoro, P. N.; Keiyoro, P. N.; Kemp, A. H.; Kengne, A. P.; Wiysonge, C. S.; Sliwa, K.; Kengne, A. P.; Keren, A.; Khader, Y. S.; Khan, E. A.; Khang, Y. H.; Won, S.; Khosravi, A.; Khubchandani, J.; Kim, Y. J.; Kokubo, Y.; Kosen, S.; Koul, P. A.; Koyanagi, A.; Krishnaswami, S.; Defo, B. Kuate; Defo, B. Kuate; Bicer, B. Kucuk; Lam, H.; Lan, Q.; Laryea, D. O.; Leung, R.; Li, Y.; Lipshultz, S. E.; Wilkinson, J. D.; Lipshultz, S. E.; Simard, E. P.; Liu, Y.; Phillips, M. R.; Xiao, Q.; Lloyd, B. K.; Lloyd, B. K.; Lunevicius, R.; Lunevicius, R.; Pope, D.; Ma, S.; Ma, S.; Abd El Razek, H. Magdy; Abd El Razek, M. Magdy; Marcenes, W.; Meaney, P. A.; Margolis, D. J.; Marzan, M. B.; Mason-Jones, A. J.; Mazorodze, T. T.; Meaney, P. A.; Mehari, A.; Mehndiratta, M. M.; Woldeyohannes, S. M.; Mekonnen, A. B.; Tedla, B. A.; Tessema, G. A.; Memish, Z. A.; Memish, Z. A.; Mendoza, W.; Meretoja, A.; Meretoja, T. J.; Meretoja, T. J.; Mhimbira, F. A.; Miller, T. R.; Miller, T. R.; Mills, E. J.; Mohamed Ibrahim, N.; Mohammad, K. A.; Mohammadi, A.; Mohammed, S.; Mola, G. L.D.; Monasta, L.; Montico, M.; Ronfani, L.; Monis, J. D.; Moore, A. R.; Moradilakeh, M.; Morawska, L.; Norman, R. E.; Mori, R.; Werdecker, A.; Mueller, U. O.; Westerman, R.; Murthy, G. V.S.; Lal, D. K.; Zodpey, S.; Murthy, S.; Pourmalek, F.; Nachega, J. B.; Paternina Caicedo, A. J.; Nachega, J. B.; Seedat, S.; Wiysonge, C. S.; Nachega, J. B.; Tran, B. X.; Naheed, A.; Naldi, L.; Remuzzi, G.; Nand, D.; Nangia, V.; Nash, D.; Neupane, S.; Newton, J. N.; Ngalesoni, F. N.; Nguhiu, P.; Nguyen, Q. L.; Nomura, M.; Nyakarahuka, L.; Obermeyer, C. M.; Ogbo, F. A.; Oh, I.; Olivares, P. R.; Olusanya, B. O.; Olusanya, J. O.; Opio, J. N.; Oren, E.; Ota, E.; Oyekale, A. S.; Mahesh, P. A.; Papantoniou, N.; Stathopoulou, V.; Park, E.; Park, H.; Paternina Caicedo, A. J.; Patten, S. B.; Paul, V. K.; Roy, A.; Sagar, R.; Satpathy, M.; Pereira, D. M.; Cortinovis, M.; Perico, N.; Remuzzi, G.; Pesudovs, K.; Tesfay, F. H.; Petzold, M.; Petzold, M.; Phillips, M. R.; Pillay, J. D.; Polinder, S.; Qorbani, M.; Rafay, A.; Rahman, M.; Rahman, S. U.; Rai, R. K.; Ranabhat, C. L.; Rangaswamy, T.; Rao, P. V.; Rao, P. V.; Refaat, A. H.; Remuzzi, G.; Resnikoff, S.; Rojas-Rueda, D.; Roshandel, G.; Ruhago, G. M.; Sunguya, B. F.; Saleh, M. M.; Sanabria, J. R.; Sanabria, J. R.; Sanchez-Niño, M. D.; Sarmiento-Suarez, R.; Sartorius, B.; Sawhney, M.; Saylan, M. I.; Schneider, I. J.C.; Silva, D. A.S.; Servan-Mori, E. E.; Shaikh, M. A.; Sharma, R.; Shen, J.; Shin, M.; Yoon, S.; Shiri, R.; Shishani, K.; Shiue, I.; Shiue, I.; Sigfusdottir, I. D.; Silveira, D. G.A.; Silverberg, J. I.; Yano, Y.; Singh, O. P.; Singh, P. K.; Singh, V.; Soneji, S.; Soriano, J. B.; Sposato, L. A.; Sreeramareddy, C. T.; Stroumpoulis, K.; Stroumpoulis, K.; Swaminathan, S.; Sykes, B. L.; Tabarés-Seisdedos, R.; Tabb, K. M.; Talongwa, R. T.; Tavakkoli, M.; Taye, B.; Tedla, B. A.; Endries, A. Y.; Temam Shifa, G.; Terkawi, A. S.; Terkawi, A. S.; Thomson, A. J.; Thorne-Lyman, A. L.; Tobe-Gai, R.; Topor-Madry, R.; Topor-Madry, R.; Towbin, J. A.; Towbin, J. A.; Towbin, J. A.; Tran, B. X.; Tsala Dimbuene, Z.; Tyrovolas, S.; Ukwaja, K. N.; Uthman, O. A.; Vasankari, T.; Venketasubramanian, N.; Violante, F. S.; Vladimirov, S. K.; Vlassov, V. V.; Weichenthal, S.; Weiderpass, E.; Weiderpass, E.; Weiderpass, E.; Weintraub, R. G.; Westerman, R.; Wijeratne, T.; Wilkinson, J. D.; Wolfe, C. D.; Wubshet, M.; Xu, G.; Yakob, B.; Yebyo, H. G.; Yip, P.; Yonemoto, N.; Younis, M. Z.; Yu, C.; Zaidi, Z.; Zaki, M. E.; Zeeb, H.; Zhao, Y.; Zuhlke, L. J.

In: The Lancet, Vol. 388, No. 10053, 08.10.2016, p. 1775-1812.

Research output: Contribution to journalArticle

Kassebaum, NJ, Barber, RM, Dandona, L, Hay, SI, Larson, HJ, Lim, SS, Lopez, AD, Mokdad, AH, Naghavi, M, Pinho, C, Steiner, C, Vos, T, Wang, H, Achoki, T, Anderson, GM, Arora, M, Biryukov, S, Blore, JD, Carter, A, Casey, DC, Coates, MM, Coggeshall, M, Dicker, DJ, Dossou, E, Fleming, T, Fraser, MS, Friedman, J, Fullman, N, Graetz, N, Hancock, J, Huynh, C, Iannarone, M, Kemmer, L, Kulikoff, XR, Kutz, MJ, Liu, PY, Marquez, N, Misganaw, A, Mooney, MD, Moradi-Lakeh, M, Ng, M, Nguyen, G, Pain, A, Shackelford, KA, Silpakit, N, Sligar, A, Smith, JM, Sorensen, RJD, Vollset, SE, Wagner, JA, Wolock, T, Zhao, Y, Zhou, M, Murray, CJL, Ebel, BE, Futran, ND, Harun, KM, Bhutta, ZA, Nisar, MI, Akseer, N, Bhutta, ZA, Jeemon, P, Dandona, L, Dandona, R, Goenka, S, Kumar, GA, Gething, PW, Bisanzio, D, Deribew, A, Cooper, C, Hay, SI, Ali, R, Bennett, DA, Jha, V, Rahimi, K, Kinfu, Y, Larson, HJ, Murthy, GVS, Li, Y, Liu, S, Wang, L, Zhou, M, Liang, X, Yu, S, Lopez, AD, Azzopardi, P, Gibney, KB, Meretoja, A, Szoeke, CEI, Azzopardi, P, Alam, K, Colquhoun, SM, Weintraub, RG, Alam, K, Colquhoun, SM, Wijeratne, T, Lozano, R, Campos-Nonato, IR, Campuzano, JC, Gomez-Dantes, H, Lamadrid-Figueroa, H, Mejia-Rodriguez, F, Montañez Hernandez, JC, Montero, P, Mensah, GA, Salomon, JA, Thorne-Lyman, AL, Ajala, ON, Bärnighausen, T, Campos-Nonato, IR, Ding, EL, Farvid, MS, Fitchett, JRA, Abajobir, AA, Knibbs, LD, Lalloo, R, Alam, NKM, Guo, Y, Abate, KH, Gebrehiwot, TT, Gebremedhin, AT, Abbas, KM, Abd-Allah, F, Abdallat, MA, Abdulle, AM, Abera, SF, Melaku, YA, Tesfay, FH, Aregay, AF, Bayou, TA, Betsu, BD, Gebremedhin, M, Gebru, AA, Hailu, GB, Tekle, T, Yalew, AZ, Yebyo, HG, Abera, SF, Abera, SF, Aboyans, V, Abubakar, I, Aldridge, RW, Banerjee, A, Aburmeileh, NM, Adebiyi, AO, Adelekan, AL, Ojelabi, FA, Adebiyi, AO, Adedeji, IA, Adelekan, AL, Adou, AK, Afanvi, KA, Afanvi, KA, Akseer, N, Badawi, A, Agarwal, A, Agarwal, A, Kiadaliri, AA, Kiadaliri, AA, Ajala, ON, Akinyemiju, TF, Schwebel, DC, Singh, JA, Al-Aly, Z, Alam, K, Kemp, AH, Leigh, J, Mekonnen, AB, Alam, NKM, Alasfoor, D, Aldhahri, SF, Terkawi, AS, Aldhahri, SF, Alhabib, S, Alkerwi, A, Alla, F, Al-Raddadi, R, Alsharif, U, Martin, EA, Alvis-Guzman, N, Amare, AT, Melaku, YA, Ciobanu, LG, Tessema, GA, Amare, AT, Setegn, T, Amberbir, A, Amegah, AK, Kudom, AA, Ammar, W, Harb, HL, Amrock, SM, Andersen, HH, Antoine, RM, Antonio, CAT, Faraon, EJA, Ärnlöv, J, Larsson, A, Ärnlöv, J, Arsic Arsenijevic, VS, Barac, A, Arsic Arsenijevic, VS, Artaman, A, Asayesh, H, Atique, S, Avokpaho, EFGA, Avokpaho, EFGA, Awasthi, A, Ayala Quintanilla, BP, Ayala Quintanilla, BP, Azzopardi, P, Bacha, U, Badawi, A, Bahit, MC, Balakrishnan, K, Barker-Collo, SL, Bärnighausen, T, Bärnighausen, T, Mohammed, S, Basu, S, Bayou, YT, Bazargan-Hejazi, S, Bazargan-Hejazi, S, Bazargan-Hejazi, S, Beardsley, J, Bedi, N, Bekele, T, Bell, ML, Biroscak, BJ, Huang, JJ, Santos, IS, Bensenor, IM, Lotufo, PA, Berhane, A, Wolfe, CD, Bernabé, E, Beyene, AS, Biadgilign, S, Bikbov, B, Cooper, LTJ, Biroscak, BJ, Bjertness, E, Htet, AS, Brainin, M, Brazinova, A, Majdan, M, Brazinova, A, Shen, J, Breitborde, NJK, Brugha, TS, Butt, ZA, Cárdenas, R, Fereshtehnejad, S, Kivipelto, M, Weiderpass, E, Havmoeller, R, Sindi, S, Castañeda-Orjuela, CA, Castañedaorjuela, CA, Castro, RE, Catalá-López, F, Catalá-López, F, Cavalleri, F, Colistro, V, Chang, H, Chang, H, Chang, J, Chavan, L, Chibueze, CE, Chisumpa, VH, Mapoma, CC, Masiye, F, Chisumpa, VH, Choi, JJ, Chowdhury, R, Christopher, DJ, Cirillo, M, Colistro, V, Cooper, C, Cooper, C, Cooper, LT, Dahiru, T, Damasceno, A, Danawi, H, Refaat, AH, Neves, JD, Santos, JV, De Leo, D, Dellavalle, RP, Deribe, K, Deribe, K, Hailu, AD, Tefera, W, Giref, AZ, Jibat, T, Shifa, GT, Deribew, A, Des Jarlais, DC, Des Jarlais, DC, Dharmaratne, SD, Dubey, M, Rahman, MHU, Ram, U, Singh, A, Yadav, AK, Vollset, SE, Ellingsen, CL, Savic, M, Skirbekk, V, Elyazar, I, Ermakov, SP, Ermakov, SP, Soshnikov, S, Eshrati, B, Eshrati, B, Farzadfar, F, Kasaeian, A, Pishgar, F, Esteghamati, A, Hafezi-Nejad, N, Sheikhbahaei, S, Kasaeian, A, Khosravi, A, Malekzadeh, R, Roshandel, G, Sepanlou, SG, Pishgar, F, Rahimi-Movaghar, V, Faraon, EJA, Farid, TA, Khan, AR, Farinha, CSES, Farinha, CSES, Faro, A, Farvid, MS, Fernandes, JC, Fischer, F, Foigt, N, Franca, EB, Franklin, RC, Fürst, T, Majeed, A, Fürst, T, Fürst, T, Gambashidze, K, Kazanjan, K, Kereselidze, M, Khonelidze, I, Shakh-Nazarova, M, Sturua, L, Gamkrelidze, A, Gebre, T, Gebremedhin, AT, Gebru, AA, Hailu, GB, Geleijnse, JM, Jibat, T, Gibney, KB, Giroud, M, Gishu, MD, Tura, AK, Gishu, MD, Glaser, E, Gona, P, Goodridge, A, Gopalani, SV, Goto, A, Gugnani, HC, Gupta, R, Gupta, R, Gupta, V, Vollset, SE, Hailu, AD, Norheim, OF, Hamadeh, RR, Hamidi, S, Handal, AJ, Hankey, GJ, Hankey, GJ, Hankey, GJ, Harikrishnan, S, Harun, KM, Hoek, HW, Tura, AK, Hoek, HW, Skirbekk, V, Horino, M, Horino, M, Horita, N, Hosgood, HD, Hoy, DG, Htet, AS, Hu, G, Huang, H, Huybrechts, I, Huybrechts, I, Iburg, KM, Idrisov, BT, Idrisov, BT, Iyer, VJ, Jacobsen, KH, Jahanmehr, N, Jakovljevic, MB, Javanbakht, M, Jayatilleke, AU, Jayatilleke, AU, Jee, SH, Jeemon, P, Jeemon, P, Lal, DK, Zodpey, S, Jha, V, Jiang, G, Jiang, Y, Jonas, JB, Kabir, Z, Kamal, R, Kesavachandran, CN, She, J, Kan, H, Karch, A, Karch, A, Karletsos, D, Kaul, A, Kawakami, N, Shibuya, K, Kayibanda, JF, Kazi, DS, Keiyoro, PN, Keiyoro, PN, Kemp, AH, Kengne, AP, Wiysonge, CS, Sliwa, K, Kengne, AP, Keren, A, Khader, YS, Khan, EA, Khang, YH, Won, S, Khosravi, A, Khubchandani, J, Kim, YJ, Kokubo, Y, Kosen, S, Koul, PA, Koyanagi, A, Krishnaswami, S, Defo, BK, Defo, BK, Bicer, BK, Lam, H, Lan, Q, Laryea, DO, Leung, R, Li, Y, Lipshultz, SE, Wilkinson, JD, Lipshultz, SE, Simard, EP, Liu, Y, Phillips, MR, Xiao, Q, Lloyd, BK, Lloyd, BK, Lunevicius, R, Lunevicius, R, Pope, D, Ma, S, Ma, S, Abd El Razek, HM, Abd El Razek, MM, Marcenes, W, Meaney, PA, Margolis, DJ, Marzan, MB, Mason-Jones, AJ, Mazorodze, TT, Meaney, PA, Mehari, A, 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Cortinovis, M, Perico, N, Remuzzi, G, Pesudovs, K, Tesfay, FH, Petzold, M, Petzold, M, Phillips, MR, Pillay, JD, Polinder, S, Qorbani, M, Rafay, A, Rahman, M, Rahman, SU, Rai, RK, Ranabhat, CL, Rangaswamy, T, Rao, PV, Rao, PV, Refaat, AH, Remuzzi, G, Resnikoff, S, Rojas-Rueda, D, Roshandel, G, Ruhago, GM, Sunguya, BF, Saleh, MM, Sanabria, JR, Sanabria, JR, Sanchez-Niño, MD, Sarmiento-Suarez, R, Sartorius, B, Sawhney, M, Saylan, MI, Schneider, IJC, Silva, DAS, Servan-Mori, EE, Shaikh, MA, Sharma, R, Shen, J, Shin, M, Yoon, S, Shiri, R, Shishani, K, Shiue, I, Shiue, I, Sigfusdottir, ID, Silveira, DGA, Silverberg, JI, Yano, Y, Singh, OP, Singh, PK, Singh, V, Soneji, S, Soriano, JB, Sposato, LA, Sreeramareddy, CT, Stroumpoulis, K, Stroumpoulis, K, Swaminathan, S, Sykes, BL, Tabarés-Seisdedos, R, Tabb, KM, Talongwa, RT, Tavakkoli, M, Taye, B, Tedla, BA, Endries, AY, Temam Shifa, G, Terkawi, AS, Terkawi, AS, Thomson, AJ, Thorne-Lyman, AL, Tobe-Gai, R, Topor-Madry, R, Topor-Madry, R, Towbin, JA, Towbin, JA, Towbin, JA, Tran, BX, Tsala Dimbuene, Z, Tyrovolas, S, Ukwaja, KN, Uthman, OA, Vasankari, T, Venketasubramanian, N, Violante, FS, Vladimirov, SK, Vlassov, VV, Weichenthal, S, Weiderpass, E, Weiderpass, E, Weiderpass, E, Weintraub, RG, Westerman, R, Wijeratne, T, Wilkinson, JD, Wolfe, CD, Wubshet, M, Xu, G, Yakob, B, Yebyo, HG, Yip, P, Yonemoto, N, Younis, MZ, Yu, C, Zaidi, Z, Zaki, ME, Zeeb, H, Zhao, Y & Zuhlke, LJ 2016, 'Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015', The Lancet, vol. 388, no. 10053, pp. 1775-1812. https://doi.org/10.1016/S0140-6736(16)31470-2
Kassebaum, N. J. ; Barber, R. M. ; Dandona, L. ; Hay, S. I. ; Larson, H. J. ; Lim, S. S. ; Lopez, A. D. ; Mokdad, A. H. ; Naghavi, M. ; Pinho, C. ; Steiner, C. ; Vos, T. ; Wang, H. ; Achoki, T. ; Anderson, G. M. ; Arora, M. ; Biryukov, S. ; Blore, J. D. ; Carter, A. ; Casey, D. C. ; Coates, M. M. ; Coggeshall, M. ; Dicker, D. J. ; Dossou, E. ; Fleming, T. ; Fraser, M. S. ; Friedman, J. ; Fullman, N. ; Graetz, N. ; Hancock, J. ; Huynh, C. ; Iannarone, M. ; Kemmer, L. ; Kulikoff, X. R. ; Kutz, M. J. ; Liu, P. Y. ; Marquez, N. ; Misganaw, A. ; Mooney, M. D. ; Moradi-Lakeh, M. ; Ng, M. ; Nguyen, G. ; Pain, A. ; Shackelford, K. A. ; Silpakit, N. ; Sligar, A. ; Smith, J. M. ; Sorensen, R. J.D. ; Vollset, S. E. ; Wagner, J. A. ; Wolock, T. ; Zhao, Y. ; Zhou, M. ; Murray, C. J.L. ; Ebel, B. E. ; Futran, N. D. ; Harun, K. M. ; Bhutta, Z. A. ; Nisar, M. I. ; Akseer, N. ; Bhutta, Z. A. ; Jeemon, P. ; Dandona, L. ; Dandona, R. ; Goenka, S. ; Kumar, G. A. ; Gething, P. W. ; Bisanzio, D. ; Deribew, A. ; Cooper, C. ; Hay, S. I. ; Ali, R. ; Bennett, D. A. ; Jha, V. ; Rahimi, K. ; Kinfu, Y. ; Larson, H. J. ; Murthy, G. V.S. ; Li, Y. ; Liu, S. ; Wang, L. ; Zhou, M. ; Liang, X. ; Yu, S. ; Lopez, A. D. ; Azzopardi, P. ; Gibney, K. B. ; Meretoja, A. ; Szoeke, C. E.I. ; Azzopardi, P. ; Alam, K. ; Colquhoun, S. M. ; Weintraub, R. G. ; Alam, K. ; Colquhoun, S. M. ; Wijeratne, T. ; Lozano, R. ; Campos-Nonato, I. R. ; Campuzano, J. C. ; Gomez-Dantes, H. ; Lamadrid-Figueroa, H. ; Mejia-Rodriguez, F. ; Montañez Hernandez, J. C. ; Montero, P. ; Mensah, G. A. ; Salomon, J. A. ; Thorne-Lyman, A. L. ; Ajala, O. N. ; Bärnighausen, T. ; Campos-Nonato, I. R. ; Ding, E. L. ; Farvid, M. S. ; Fitchett, J. R.A. ; Abajobir, A. A. ; Knibbs, L. D. ; Lalloo, R. ; Alam, N. K.M. ; Guo, Y. ; Abate, K. H. ; Gebrehiwot, T. T. ; Gebremedhin, A. T. ; Abbas, K. M. ; Abd-Allah, F. ; Abdallat, M. A. ; Abdulle, A. M. ; Abera, S. F. ; Melaku, Y. A. ; Tesfay, F. H. ; Aregay, A. F. ; Bayou, T. A. ; Betsu, B. D. ; Gebremedhin, M. ; Gebru, A. A. ; Hailu, G. B. ; Tekle, T. ; Yalew, A. Z. ; Yebyo, H. G. ; Abera, S. F. ; Abera, S. F. ; Aboyans, V. ; Abubakar, I. ; Aldridge, R. W. ; Banerjee, A. ; Aburmeileh, N. M. ; Adebiyi, A. O. ; Adelekan, A. L. ; Ojelabi, F. A. ; Adebiyi, A. O. ; Adedeji, I. A. ; Adelekan, A. L. ; Adou, A. K. ; Afanvi, K. A. ; Afanvi, K. A. ; Akseer, N. ; Badawi, A. ; Agarwal, A. ; Agarwal, A. ; Kiadaliri, A. Ahmad ; Kiadaliri, A. Ahmad ; Ajala, O. N. ; Akinyemiju, T. F. ; Schwebel, D. C. ; Singh, J. A. ; Al-Aly, Z. ; Alam, K. ; Kemp, A. H. ; Leigh, J. ; Mekonnen, A. B. ; Alam, N. K.M. ; Alasfoor, D. ; Aldhahri, S. F. ; Terkawi, A. S. ; Aldhahri, S. F. ; Alhabib, S. ; Alkerwi, A. ; Alla, F. ; Al-Raddadi, R. ; Alsharif, U. ; Martin, E. Alvarez ; Alvis-Guzman, N. ; Amare, A. T. ; Melaku, Y. A. ; Ciobanu, L. G. ; Tessema, G. A. ; Amare, A. T. ; Setegn, T. ; Amberbir, A. ; Amegah, A. K. ; Kudom, A. A. ; Ammar, W. ; Harb, H. L. ; Amrock, S. M. ; Andersen, H. H. ; Antoine, R. M. ; Antonio, C. A.T. ; Faraon, E. J.A. ; Ärnlöv, J. ; Larsson, A. ; Ärnlöv, J. ; Arsic Arsenijevic, V. S. ; Barac, A. ; Arsic Arsenijevic, V. S. ; Artaman, A. ; Asayesh, H. ; Atique, S. ; Avokpaho, E. F.G.A. ; Avokpaho, E. F.G.A. ; Awasthi, A. ; Ayala Quintanilla, B. P. ; Ayala Quintanilla, B. P. ; Azzopardi, P. ; Bacha, U. ; Badawi, A. ; Bahit, M. C. ; Balakrishnan, K. ; Barker-Collo, S. L. ; Bärnighausen, T. ; Bärnighausen, T. ; Mohammed, S. ; Basu, S. ; Bayou, Y. T. ; Bazargan-Hejazi, S. ; Bazargan-Hejazi, S. ; Bazargan-Hejazi, S. ; Beardsley, J. ; Bedi, N. ; Bekele, T. ; Bell, M. L. ; Biroscak, B. J. ; Huang, J. J. ; Santos, I. S. ; Bensenor, I. M. ; Lotufo, P. A. ; Berhane, A. ; Wolfe, C. D. ; Bernabé, E. ; Beyene, A. S. ; Biadgilign, S. ; Bikbov, B. ; Cooper, Leslie T Jr. ; Biroscak, B. J. ; Bjertness, E. ; Htet, A. S. ; Brainin, M. ; Brazinova, A. ; Majdan, M. ; Brazinova, A. ; Shen, J. ; Breitborde, N. J.K. ; Brugha, T. S. ; Butt, Z. 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A. ; Endries, A. Y. ; Temam Shifa, G. ; Terkawi, A. S. ; Terkawi, A. S. ; Thomson, A. J. ; Thorne-Lyman, A. L. ; Tobe-Gai, R. ; Topor-Madry, R. ; Topor-Madry, R. ; Towbin, J. A. ; Towbin, J. A. ; Towbin, J. A. ; Tran, B. X. ; Tsala Dimbuene, Z. ; Tyrovolas, S. ; Ukwaja, K. N. ; Uthman, O. A. ; Vasankari, T. ; Venketasubramanian, N. ; Violante, F. S. ; Vladimirov, S. K. ; Vlassov, V. V. ; Weichenthal, S. ; Weiderpass, E. ; Weiderpass, E. ; Weiderpass, E. ; Weintraub, R. G. ; Westerman, R. ; Wijeratne, T. ; Wilkinson, J. D. ; Wolfe, C. D. ; Wubshet, M. ; Xu, G. ; Yakob, B. ; Yebyo, H. G. ; Yip, P. ; Yonemoto, N. ; Younis, M. Z. ; Yu, C. ; Zaidi, Z. ; Zaki, M. E. ; Zeeb, H. ; Zhao, Y. ; Zuhlke, L. J. / Global, regional, and national levels of maternal mortality, 1990–2015 : a systematic analysis for the Global Burden of Disease Study 2015. In: The Lancet. 2016 ; Vol. 388, No. 10053. pp. 1775-1812.
@article{f78d2b4e112e442cad2126f4a94c83e8,
title = "Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015",
abstract = "Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68{\%} in 1990 to more than 80{\%} in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91{\%} coverage of one antenatal care visit, 78{\%} of four antenatal care visits, 81{\%} of in-facility delivery, and 87{\%} of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.",
author = "Kassebaum, {N. J.} and Barber, {R. M.} and L. Dandona and Hay, {S. I.} and Larson, {H. J.} and Lim, {S. S.} and Lopez, {A. D.} and Mokdad, {A. H.} and M. Naghavi and C. Pinho and C. Steiner and T. Vos and H. Wang and T. Achoki and Anderson, {G. M.} and M. Arora and S. Biryukov and Blore, {J. D.} and A. Carter and Casey, {D. C.} and Coates, {M. M.} and M. Coggeshall and Dicker, {D. J.} and E. Dossou and T. Fleming and Fraser, {M. S.} and J. Friedman and N. Fullman and N. Graetz and J. Hancock and C. Huynh and M. Iannarone and L. Kemmer and Kulikoff, {X. R.} and Kutz, {M. J.} and Liu, {P. Y.} and N. Marquez and A. Misganaw and Mooney, {M. D.} and M. Moradi-Lakeh and M. Ng and G. Nguyen and A. Pain and Shackelford, {K. A.} and N. Silpakit and A. Sligar and Smith, {J. M.} and Sorensen, {R. J.D.} and Vollset, {S. E.} and Wagner, {J. A.} and T. Wolock and Y. Zhao and M. Zhou and Murray, {C. J.L.} and Ebel, {B. E.} and Futran, {N. D.} and Harun, {K. M.} and Bhutta, {Z. A.} and Nisar, {M. I.} and N. Akseer and Bhutta, {Z. A.} and P. Jeemon and L. Dandona and R. Dandona and S. Goenka and Kumar, {G. A.} and Gething, {P. W.} and D. Bisanzio and A. Deribew and C. Cooper and Hay, {S. I.} and R. Ali and Bennett, {D. A.} and V. Jha and K. Rahimi and Y. Kinfu and Larson, {H. J.} and Murthy, {G. V.S.} and Y. Li and S. Liu and L. Wang and M. Zhou and X. Liang and S. Yu and Lopez, {A. D.} and P. Azzopardi and Gibney, {K. B.} and A. Meretoja and Szoeke, {C. E.I.} and P. Azzopardi and K. Alam and Colquhoun, {S. M.} and Weintraub, {R. G.} and K. Alam and Colquhoun, {S. M.} and T. Wijeratne and R. Lozano and Campos-Nonato, {I. R.} and Campuzano, {J. C.} and H. Gomez-Dantes and H. Lamadrid-Figueroa and F. Mejia-Rodriguez and {Monta{\~n}ez Hernandez}, {J. C.} and P. Montero and Mensah, {G. A.} and Salomon, {J. A.} and Thorne-Lyman, {A. L.} and Ajala, {O. N.} and T. B{\"a}rnighausen and Campos-Nonato, {I. R.} and Ding, {E. L.} and Farvid, {M. S.} and Fitchett, {J. R.A.} and Abajobir, {A. A.} and Knibbs, {L. D.} and R. Lalloo and Alam, {N. K.M.} and Y. Guo and Abate, {K. H.} and Gebrehiwot, {T. T.} and Gebremedhin, {A. T.} and Abbas, {K. M.} and F. Abd-Allah and Abdallat, {M. A.} and Abdulle, {A. M.} and Abera, {S. F.} and Melaku, {Y. A.} and Tesfay, {F. H.} and Aregay, {A. F.} and Bayou, {T. A.} and Betsu, {B. D.} and M. Gebremedhin and Gebru, {A. A.} and Hailu, {G. B.} and T. Tekle and Yalew, {A. Z.} and Yebyo, {H. G.} and Abera, {S. F.} and Abera, {S. F.} and V. Aboyans and I. Abubakar and Aldridge, {R. W.} and A. Banerjee and Aburmeileh, {N. M.} and Adebiyi, {A. O.} and Adelekan, {A. L.} and Ojelabi, {F. A.} and Adebiyi, {A. O.} and Adedeji, {I. A.} and Adelekan, {A. L.} and Adou, {A. K.} and Afanvi, {K. A.} and Afanvi, {K. A.} and N. Akseer and A. Badawi and A. Agarwal and A. Agarwal and Kiadaliri, {A. Ahmad} and Kiadaliri, {A. Ahmad} and Ajala, {O. N.} and Akinyemiju, {T. F.} and Schwebel, {D. C.} and Singh, {J. A.} and Z. Al-Aly and K. Alam and Kemp, {A. H.} and J. Leigh and Mekonnen, {A. B.} and Alam, {N. K.M.} and D. Alasfoor and Aldhahri, {S. F.} and Terkawi, {A. S.} and Aldhahri, {S. F.} and S. Alhabib and A. Alkerwi and F. Alla and R. Al-Raddadi and U. Alsharif and Martin, {E. Alvarez} and N. Alvis-Guzman and Amare, {A. T.} and Melaku, {Y. A.} and Ciobanu, {L. G.} and Tessema, {G. A.} and Amare, {A. T.} and T. Setegn and A. Amberbir and Amegah, {A. K.} and Kudom, {A. A.} and W. Ammar and Harb, {H. L.} and Amrock, {S. M.} and Andersen, {H. H.} and Antoine, {R. M.} and Antonio, {C. A.T.} and Faraon, {E. J.A.} and J. {\"A}rnl{\"o}v and A. Larsson and J. {\"A}rnl{\"o}v and {Arsic Arsenijevic}, {V. S.} and A. Barac and {Arsic Arsenijevic}, {V. S.} and A. Artaman and H. Asayesh and S. Atique and Avokpaho, {E. F.G.A.} and Avokpaho, {E. F.G.A.} and A. Awasthi and {Ayala Quintanilla}, {B. P.} and {Ayala Quintanilla}, {B. P.} and P. Azzopardi and U. Bacha and A. Badawi and Bahit, {M. C.} and K. Balakrishnan and Barker-Collo, {S. L.} and T. B{\"a}rnighausen and T. B{\"a}rnighausen and S. Mohammed and S. Basu and Bayou, {Y. T.} and S. Bazargan-Hejazi and S. Bazargan-Hejazi and S. Bazargan-Hejazi and J. Beardsley and N. Bedi and T. Bekele and Bell, {M. L.} and Biroscak, {B. J.} and Huang, {J. J.} and Santos, {I. S.} and Bensenor, {I. M.} and Lotufo, {P. A.} and A. Berhane and Wolfe, {C. D.} and E. Bernab{\'e} and Beyene, {A. S.} and S. Biadgilign and B. Bikbov and Cooper, {Leslie T Jr.} and Biroscak, {B. J.} and E. Bjertness and Htet, {A. S.} and M. Brainin and A. Brazinova and M. Majdan and A. Brazinova and J. Shen and Breitborde, {N. J.K.} and Brugha, {T. S.} and Butt, {Z. A.} and R. C{\'a}rdenas and S. Fereshtehnejad and M. Kivipelto and E. Weiderpass and R. Havmoeller and S. Sindi and Casta{\~n}eda-Orjuela, {C. A.} and Casta{\~n}edaorjuela, {C. A.} and Castro, {R. E.} and F. Catal{\'a}-L{\'o}pez and F. Catal{\'a}-L{\'o}pez and F. Cavalleri and V. Colistro and H. Chang and H. Chang and J. Chang and L. Chavan and Chibueze, {C. E.} and Chisumpa, {V. H.} and Mapoma, {C. C.} and F. Masiye and Chisumpa, {V. H.} and Choi, {J. J.} and R. Chowdhury and Christopher, {D. J.} and M. Cirillo and V. Colistro and C. Cooper and C. Cooper and Cooper, {L. T.} and T. Dahiru and A. Damasceno and H. Danawi and Refaat, {A. H.} and Neves, {J. Das} and Santos, {J. V.} and {De Leo}, D. and Dellavalle, {R. P.} and K. Deribe and K. Deribe and Hailu, {A. D.} and W. Tefera and Giref, {A. Z.} and T. Jibat and Shifa, {G. Temam} and A. Deribew and {Des Jarlais}, {D. C.} and {Des Jarlais}, {D. C.} and Dharmaratne, {S. D.} and M. Dubey and Rahman, {M. H.U.} and U. Ram and A. Singh and Yadav, {A. K.} and Vollset, {S. E.} and Ellingsen, {C. L.} and M. Savic and V. Skirbekk and I. Elyazar and Ermakov, {S. P.} and Ermakov, {S. P.} and S. Soshnikov and B. Eshrati and B. Eshrati and F. Farzadfar and A. Kasaeian and F. Pishgar and A. Esteghamati and N. Hafezi-Nejad and S. Sheikhbahaei and A. Kasaeian and A. Khosravi and R. Malekzadeh and G. Roshandel and Sepanlou, {S. G.} and F. Pishgar and V. Rahimi-Movaghar and Faraon, {E. J.A.} and Farid, {T. A.} and Khan, {A. R.} and Farinha, {C. S.E.S.} and Farinha, {C. S.E.S.} and A. Faro and Farvid, {M. S.} and Fernandes, {J. C.} and F. Fischer and N. Foigt and Franca, {E. B.} and Franklin, {R. C.} and T. F{\"u}rst and A. Majeed and T. F{\"u}rst and T. F{\"u}rst and K. Gambashidze and K. Kazanjan and M. Kereselidze and I. Khonelidze and M. Shakh-Nazarova and L. Sturua and A. Gamkrelidze and T. Gebre and Gebremedhin, {A. T.} and Gebru, {A. A.} and Hailu, {G. B.} and Geleijnse, {J. M.} and T. Jibat and Gibney, {K. B.} and M. Giroud and Gishu, {M. D.} and Tura, {A. K.} and Gishu, {M. D.} and E. Glaser and P. Gona and A. Goodridge and Gopalani, {S. V.} and A. Goto and Gugnani, {H. C.} and R. Gupta and R. Gupta and V. Gupta and Vollset, {S. E.} and Hailu, {A. D.} and Norheim, {O. F.} and Hamadeh, {R. R.} and S. Hamidi and Handal, {A. J.} and Hankey, {G. J.} and Hankey, {G. J.} and Hankey, {G. J.} and S. Harikrishnan and Harun, {K. M.} and Hoek, {H. W.} and Tura, {A. K.} and Hoek, {H. W.} and V. Skirbekk and M. Horino and M. Horino and N. Horita and Hosgood, {H. D.} and Hoy, {D. G.} and Htet, {A. S.} and G. Hu and H. Huang and I. Huybrechts and I. Huybrechts and Iburg, {K. M.} and Idrisov, {B. T.} and Idrisov, {B. T.} and Iyer, {V. J.} and Jacobsen, {K. H.} and N. Jahanmehr and Jakovljevic, {M. B.} and M. Javanbakht and Jayatilleke, {A. U.} and Jayatilleke, {A. U.} and Jee, {S. H.} and P. Jeemon and P. Jeemon and Lal, {D. K.} and S. Zodpey and V. Jha and G. Jiang and Y. Jiang and Jonas, {J. B.} and Z. Kabir and R. Kamal and Kesavachandran, {C. N.} and J. She and H. Kan and A. Karch and A. Karch and D. Karletsos and A. Kaul and N. Kawakami and K. Shibuya and Kayibanda, {J. F.} and Kazi, {D. S.} and Keiyoro, {P. N.} and Keiyoro, {P. N.} and Kemp, {A. H.} and Kengne, {A. P.} and Wiysonge, {C. S.} and K. Sliwa and Kengne, {A. P.} and A. Keren and Khader, {Y. S.} and Khan, {E. A.} and Khang, {Y. H.} and S. Won and A. Khosravi and J. Khubchandani and Kim, {Y. J.} and Y. Kokubo and S. Kosen and Koul, {P. A.} and A. Koyanagi and S. Krishnaswami and Defo, {B. Kuate} and Defo, {B. Kuate} and Bicer, {B. Kucuk} and H. Lam and Q. Lan and Laryea, {D. O.} and R. Leung and Y. Li and Lipshultz, {S. E.} and Wilkinson, {J. D.} and Lipshultz, {S. E.} and Simard, {E. P.} and Y. Liu and Phillips, {M. R.} and Q. Xiao and Lloyd, {B. K.} and Lloyd, {B. K.} and R. Lunevicius and R. Lunevicius and D. Pope and S. Ma and S. Ma and {Abd El Razek}, {H. Magdy} and {Abd El Razek}, {M. Magdy} and W. Marcenes and Meaney, {P. A.} and Margolis, {D. J.} and Marzan, {M. B.} and Mason-Jones, {A. J.} and Mazorodze, {T. T.} and Meaney, {P. A.} and A. Mehari and Mehndiratta, {M. M.} and Woldeyohannes, {S. M.} and Mekonnen, {A. B.} and Tedla, {B. A.} and Tessema, {G. A.} and Memish, {Z. A.} and Memish, {Z. A.} and W. Mendoza and A. Meretoja and Meretoja, {T. J.} and Meretoja, {T. J.} and Mhimbira, {F. A.} and Miller, {T. R.} and Miller, {T. R.} and Mills, {E. J.} and {Mohamed Ibrahim}, N. and Mohammad, {K. A.} and A. Mohammadi and S. Mohammed and Mola, {G. L.D.} and L. Monasta and M. Montico and L. Ronfani and Monis, {J. D.} and Moore, {A. R.} and M. Moradilakeh and L. Morawska and Norman, {R. E.} and R. Mori and A. Werdecker and Mueller, {U. O.} and R. Westerman and Murthy, {G. V.S.} and Lal, {D. K.} and S. Zodpey and S. Murthy and F. Pourmalek and Nachega, {J. B.} and {Paternina Caicedo}, {A. J.} and Nachega, {J. B.} and S. Seedat and Wiysonge, {C. S.} and Nachega, {J. B.} and Tran, {B. X.} and A. Naheed and L. Naldi and G. Remuzzi and D. Nand and V. Nangia and D. Nash and S. Neupane and Newton, {J. N.} and Ngalesoni, {F. N.} and P. Nguhiu and Nguyen, {Q. L.} and M. Nomura and L. Nyakarahuka and Obermeyer, {C. M.} and Ogbo, {F. A.} and I. Oh and Olivares, {P. R.} and Olusanya, {B. O.} and Olusanya, {J. O.} and Opio, {J. N.} and E. Oren and E. Ota and Oyekale, {A. S.} and Mahesh, {P. A.} and N. Papantoniou and V. Stathopoulou and E. Park and H. Park and {Paternina Caicedo}, {A. J.} and Patten, {S. B.} and Paul, {V. K.} and A. Roy and R. Sagar and M. Satpathy and Pereira, {D. M.} and M. Cortinovis and N. Perico and G. Remuzzi and K. Pesudovs and Tesfay, {F. H.} and M. Petzold and M. Petzold and Phillips, {M. R.} and Pillay, {J. D.} and S. Polinder and M. Qorbani and A. Rafay and M. Rahman and Rahman, {S. U.} and Rai, {R. K.} and Ranabhat, {C. L.} and T. Rangaswamy and Rao, {P. V.} and Rao, {P. V.} and Refaat, {A. H.} and G. Remuzzi and S. Resnikoff and D. Rojas-Rueda and G. Roshandel and Ruhago, {G. M.} and Sunguya, {B. F.} and Saleh, {M. M.} and Sanabria, {J. R.} and Sanabria, {J. R.} and Sanchez-Ni{\~n}o, {M. D.} and R. Sarmiento-Suarez and B. Sartorius and M. Sawhney and Saylan, {M. I.} and Schneider, {I. J.C.} and Silva, {D. A.S.} and Servan-Mori, {E. E.} and Shaikh, {M. A.} and R. Sharma and J. Shen and M. Shin and S. Yoon and R. Shiri and K. Shishani and I. Shiue and I. Shiue and Sigfusdottir, {I. D.} and Silveira, {D. G.A.} and Silverberg, {J. I.} and Y. Yano and Singh, {O. P.} and Singh, {P. K.} and V. Singh and S. Soneji and Soriano, {J. B.} and Sposato, {L. A.} and Sreeramareddy, {C. T.} and K. Stroumpoulis and K. Stroumpoulis and S. Swaminathan and Sykes, {B. L.} and R. Tabar{\'e}s-Seisdedos and Tabb, {K. M.} and Talongwa, {R. T.} and M. Tavakkoli and B. Taye and Tedla, {B. A.} and Endries, {A. Y.} and {Temam Shifa}, G. and Terkawi, {A. S.} and Terkawi, {A. S.} and Thomson, {A. J.} and Thorne-Lyman, {A. L.} and R. Tobe-Gai and R. Topor-Madry and R. Topor-Madry and Towbin, {J. A.} and Towbin, {J. A.} and Towbin, {J. A.} and Tran, {B. X.} and {Tsala Dimbuene}, Z. and S. Tyrovolas and Ukwaja, {K. N.} and Uthman, {O. A.} and T. Vasankari and N. Venketasubramanian and Violante, {F. S.} and Vladimirov, {S. K.} and Vlassov, {V. V.} and S. Weichenthal and E. Weiderpass and E. Weiderpass and E. Weiderpass and Weintraub, {R. G.} and R. Westerman and T. Wijeratne and Wilkinson, {J. D.} and Wolfe, {C. D.} and M. Wubshet and G. Xu and B. Yakob and Yebyo, {H. G.} and P. Yip and N. Yonemoto and Younis, {M. Z.} and C. Yu and Z. Zaidi and Zaki, {M. E.} and H. Zeeb and Y. Zhao and Zuhlke, {L. J.}",
year = "2016",
month = "10",
day = "8",
doi = "10.1016/S0140-6736(16)31470-2",
language = "English (US)",
volume = "388",
pages = "1775--1812",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "10053",

}

TY - JOUR

T1 - Global, regional, and national levels of maternal mortality, 1990–2015

T2 - a systematic analysis for the Global Burden of Disease Study 2015

AU - Kassebaum, N. J.

AU - Barber, R. M.

AU - Dandona, L.

AU - Hay, S. I.

AU - Larson, H. J.

AU - Lim, S. S.

AU - Lopez, A. D.

AU - Mokdad, A. H.

AU - Naghavi, M.

AU - Pinho, C.

AU - Steiner, C.

AU - Vos, T.

AU - Wang, H.

AU - Achoki, T.

AU - Anderson, G. M.

AU - Arora, M.

AU - Biryukov, S.

AU - Blore, J. D.

AU - Carter, A.

AU - Casey, D. C.

AU - Coates, M. M.

AU - Coggeshall, M.

AU - Dicker, D. J.

AU - Dossou, E.

AU - Fleming, T.

AU - Fraser, M. S.

AU - Friedman, J.

AU - Fullman, N.

AU - Graetz, N.

AU - Hancock, J.

AU - Huynh, C.

AU - Iannarone, M.

AU - Kemmer, L.

AU - Kulikoff, X. R.

AU - Kutz, M. J.

AU - Liu, P. Y.

AU - Marquez, N.

AU - Misganaw, A.

AU - Mooney, M. D.

AU - Moradi-Lakeh, M.

AU - Ng, M.

AU - Nguyen, G.

AU - Pain, A.

AU - Shackelford, K. A.

AU - Silpakit, N.

AU - Sligar, A.

AU - Smith, J. M.

AU - Sorensen, R. J.D.

AU - Vollset, S. E.

AU - Wagner, J. A.

AU - Wolock, T.

AU - Zhao, Y.

AU - Zhou, M.

AU - Murray, C. J.L.

AU - Ebel, B. E.

AU - Futran, N. D.

AU - Harun, K. M.

AU - Bhutta, Z. A.

AU - Nisar, M. I.

AU - Akseer, N.

AU - Bhutta, Z. A.

AU - Jeemon, P.

AU - Dandona, L.

AU - Dandona, R.

AU - Goenka, S.

AU - Kumar, G. A.

AU - Gething, P. W.

AU - Bisanzio, D.

AU - Deribew, A.

AU - Cooper, C.

AU - Hay, S. I.

AU - Ali, R.

AU - Bennett, D. A.

AU - Jha, V.

AU - Rahimi, K.

AU - Kinfu, Y.

AU - Larson, H. J.

AU - Murthy, G. V.S.

AU - Li, Y.

AU - Liu, S.

AU - Wang, L.

AU - Zhou, M.

AU - Liang, X.

AU - Yu, S.

AU - Lopez, A. D.

AU - Azzopardi, P.

AU - Gibney, K. B.

AU - Meretoja, A.

AU - Szoeke, C. E.I.

AU - Azzopardi, P.

AU - Alam, K.

AU - Colquhoun, S. M.

AU - Weintraub, R. G.

AU - Alam, K.

AU - Colquhoun, S. M.

AU - Wijeratne, T.

AU - Lozano, R.

AU - Campos-Nonato, I. R.

AU - Campuzano, J. C.

AU - Gomez-Dantes, H.

AU - Lamadrid-Figueroa, H.

AU - Mejia-Rodriguez, F.

AU - Montañez Hernandez, J. C.

AU - Montero, P.

AU - Mensah, G. A.

AU - Salomon, J. A.

AU - Thorne-Lyman, A. L.

AU - Ajala, O. N.

AU - Bärnighausen, T.

AU - Campos-Nonato, I. R.

AU - Ding, E. L.

AU - Farvid, M. S.

AU - Fitchett, J. R.A.

AU - Abajobir, A. A.

AU - Knibbs, L. D.

AU - Lalloo, R.

AU - Alam, N. K.M.

AU - Guo, Y.

AU - Abate, K. H.

AU - Gebrehiwot, T. T.

AU - Gebremedhin, A. T.

AU - Abbas, K. M.

AU - Abd-Allah, F.

AU - Abdallat, M. A.

AU - Abdulle, A. M.

AU - Abera, S. F.

AU - Melaku, Y. A.

AU - Tesfay, F. H.

AU - Aregay, A. F.

AU - Bayou, T. A.

AU - Betsu, B. D.

AU - Gebremedhin, M.

AU - Gebru, A. A.

AU - Hailu, G. B.

AU - Tekle, T.

AU - Yalew, A. Z.

AU - Yebyo, H. G.

AU - Abera, S. F.

AU - Abera, S. F.

AU - Aboyans, V.

AU - Abubakar, I.

AU - Aldridge, R. W.

AU - Banerjee, A.

AU - Aburmeileh, N. M.

AU - Adebiyi, A. O.

AU - Adelekan, A. L.

AU - Ojelabi, F. A.

AU - Adebiyi, A. O.

AU - Adedeji, I. A.

AU - Adelekan, A. L.

AU - Adou, A. K.

AU - Afanvi, K. A.

AU - Afanvi, K. A.

AU - Akseer, N.

AU - Badawi, A.

AU - Agarwal, A.

AU - Agarwal, A.

AU - Kiadaliri, A. Ahmad

AU - Kiadaliri, A. Ahmad

AU - Ajala, O. N.

AU - Akinyemiju, T. F.

AU - Schwebel, D. C.

AU - Singh, J. A.

AU - Al-Aly, Z.

AU - Alam, K.

AU - Kemp, A. H.

AU - Leigh, J.

AU - Mekonnen, A. B.

AU - Alam, N. K.M.

AU - Alasfoor, D.

AU - Aldhahri, S. F.

AU - Terkawi, A. S.

AU - Aldhahri, S. F.

AU - Alhabib, S.

AU - Alkerwi, A.

AU - Alla, F.

AU - Al-Raddadi, R.

AU - Alsharif, U.

AU - Martin, E. Alvarez

AU - Alvis-Guzman, N.

AU - Amare, A. T.

AU - Melaku, Y. A.

AU - Ciobanu, L. G.

AU - Tessema, G. A.

AU - Amare, A. T.

AU - Setegn, T.

AU - Amberbir, A.

AU - Amegah, A. K.

AU - Kudom, A. A.

AU - Ammar, W.

AU - Harb, H. L.

AU - Amrock, S. M.

AU - Andersen, H. H.

AU - Antoine, R. M.

AU - Antonio, C. A.T.

AU - Faraon, E. J.A.

AU - Ärnlöv, J.

AU - Larsson, A.

AU - Ärnlöv, J.

AU - Arsic Arsenijevic, V. S.

AU - Barac, A.

AU - Arsic Arsenijevic, V. S.

AU - Artaman, A.

AU - Asayesh, H.

AU - Atique, S.

AU - Avokpaho, E. F.G.A.

AU - Avokpaho, E. F.G.A.

AU - Awasthi, A.

AU - Ayala Quintanilla, B. P.

AU - Ayala Quintanilla, B. P.

AU - Azzopardi, P.

AU - Bacha, U.

AU - Badawi, A.

AU - Bahit, M. C.

AU - Balakrishnan, K.

AU - Barker-Collo, S. L.

AU - Bärnighausen, T.

AU - Bärnighausen, T.

AU - Mohammed, S.

AU - Basu, S.

AU - Bayou, Y. T.

AU - Bazargan-Hejazi, S.

AU - Bazargan-Hejazi, S.

AU - Bazargan-Hejazi, S.

AU - Beardsley, J.

AU - Bedi, N.

AU - Bekele, T.

AU - Bell, M. L.

AU - Biroscak, B. J.

AU - Huang, J. J.

AU - Santos, I. S.

AU - Bensenor, I. M.

AU - Lotufo, P. A.

AU - Berhane, A.

AU - Wolfe, C. D.

AU - Bernabé, E.

AU - Beyene, A. S.

AU - Biadgilign, S.

AU - Bikbov, B.

AU - Cooper, Leslie T Jr.

AU - Biroscak, B. J.

AU - Bjertness, E.

AU - Htet, A. S.

AU - Brainin, M.

AU - Brazinova, A.

AU - Majdan, M.

AU - Brazinova, A.

AU - Shen, J.

AU - Breitborde, N. J.K.

AU - Brugha, T. S.

AU - Butt, Z. A.

AU - Cárdenas, R.

AU - Fereshtehnejad, S.

AU - Kivipelto, M.

AU - Weiderpass, E.

AU - Havmoeller, R.

AU - Sindi, S.

AU - Castañeda-Orjuela, C. A.

AU - Castañedaorjuela, C. A.

AU - Castro, R. E.

AU - Catalá-López, F.

AU - Catalá-López, F.

AU - Cavalleri, F.

AU - Colistro, V.

AU - Chang, H.

AU - Chang, H.

AU - Chang, J.

AU - Chavan, L.

AU - Chibueze, C. E.

AU - Chisumpa, V. H.

AU - Mapoma, C. C.

AU - Masiye, F.

AU - Chisumpa, V. H.

AU - Choi, J. J.

AU - Chowdhury, R.

AU - Christopher, D. J.

AU - Cirillo, M.

AU - Colistro, V.

AU - Cooper, C.

AU - Cooper, C.

AU - Cooper, L. T.

AU - Dahiru, T.

AU - Damasceno, A.

AU - Danawi, H.

AU - Refaat, A. H.

AU - Neves, J. Das

AU - Santos, J. V.

AU - De Leo, D.

AU - Dellavalle, R. P.

AU - Deribe, K.

AU - Deribe, K.

AU - Hailu, A. D.

AU - Tefera, W.

AU - Giref, A. Z.

AU - Jibat, T.

AU - Shifa, G. Temam

AU - Deribew, A.

AU - Des Jarlais, D. C.

AU - Des Jarlais, D. C.

AU - Dharmaratne, S. D.

AU - Dubey, M.

AU - Rahman, M. H.U.

AU - Ram, U.

AU - Singh, A.

AU - Yadav, A. K.

AU - Vollset, S. E.

AU - Ellingsen, C. L.

AU - Savic, M.

AU - Skirbekk, V.

AU - Elyazar, I.

AU - Ermakov, S. P.

AU - Ermakov, S. P.

AU - Soshnikov, S.

AU - Eshrati, B.

AU - Eshrati, B.

AU - Farzadfar, F.

AU - Kasaeian, A.

AU - Pishgar, F.

AU - Esteghamati, A.

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PY - 2016/10/8

Y1 - 2016/10/8

N2 - Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.

AB - Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. Funding Bill & Melinda Gates Foundation.

UR - http://www.scopus.com/inward/record.url?scp=84994092884&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994092884&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(16)31470-2

DO - 10.1016/S0140-6736(16)31470-2

M3 - Article

C2 - 27733286

AN - SCOPUS:84994092884

VL - 388

SP - 1775

EP - 1812

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10053

ER -