Maternal Death Studies Spark Public Health Debate

(April 14) -- Editors of a prestigious medical journal and experts at the United Nations are clashing over global maternal death rates, with the dispute revealing how politics can play into public health issues.

On Monday, researchers at the University of Washington published surprising findings in The Lancet medical journal, concluding that maternal deaths worldwide have dropped 35 percent in the last three decades, going from 526,300 in 1980 to 342,900 in 2008.

The team, led by Dr. Christopher Murray at the Institute for Health Metrics and Evaluation, used death records, census information and published studies from 181 countries to yield a computer analysis of maternal deaths, defined as those occurring during or within 42 days of giving birth, from either a complication of the birth or a pre-existing condition aggravated by childbearing.

Despite the good news, the team's model raised serious questions about maternal death rates in the United States and Canada, which were surprisingly high. In the U.S., rates went from 12 per 100,000 live births in 1980 to 17 per 100,000 in 2008 -- twice the rate in Britain, and three times the rate in Australia.

Some of the increase could be attributed to how American health providers keep tabs on deaths: It wasn't until 1999 that death certificates included a section to indicate pregnancy. But, the researchers note, ongoing problems with American health care, along with rising rates of obesity and diabetes -- which can complicate a pregnancy -- are also likely culprits.

Globally, "these findings are very encouraging and quite surprising," Murray told Reuters. "There are still too many mothers dying worldwide, but now we have a greater reason for optimism than has generally been perceived."

But it's an optimism not shared by some health agencies, which reportedly requested that the Lancet hold off on releasing the study's results for fear that they could curb funding for important reproductive health programs.

Dr. Richard Horton, The Lancet's editor-in-chief, wrote in a commentary accompanying the study that "there needs to be serious reflection among the global health community about how it responds to new data."

In particular, Horton noted that health organizations were concerned that the study's information would cause "political damage to maternal advocacy campaigns," and "confusion among countries, policymakers and the media," because its estimates differed significantly from those recently cited by the United Nations.

"Although well-intentioned, these requests to slow the pace of scientific discussion for political considerations are likely to be far more damaging than fostering a serious debate about progress in reducing maternal mortality as and when new data appear," Horton wrote.

Horton declined to cite the agencies behind the push but told The New York Times that they were hoping to hold the results until after several key meetings, including one hosted by the U.N. in New York this week, where funding for reproductive health would be on the table.

Indeed, the results of this latest study are in stark contrast to recent reports from the World Health Organization and the U.N. Both organizations hold that maternal death rates have remained steady at around 500,000 over the last few decades.

Despite conveying a degree of optimism, the University of Washington study still illustrates that problems persist in developing countries. More than half of all maternal deaths are concentrated in six nations: India, Nigeria, Pakistan, Ethiopia, the Democratic Republic of the Congo and Afghanistan, which had the highest mortality rate worldwide.

China, India and Brazil all saw significant decreases in maternal deaths between 1980 and 2008. Their large populations were a major factor in the data cited. Several countries in sub-Saharan Africa also saw decreases, in large part because of success in mitigating rates of HIV/AIDS.

And at least one agency, the Partnership for Maternal, Newborn and Child Health, which is operated under the WHO, thinks The Lancet study could actually bolster funding for strategies to push maternal death rates even lower.

"Progress is possible and must be pursued vigorously. This will reassure our investors that their commitments are paying off," reads a statement from the agency's director, Dr. Flavia Bustreo. "Now is the time to redouble our efforts."

A report issued by the partnership just this week concluded that maternal deaths remained high worldwide, between 350,000 and 500,000 a year. "The debate on numbers may continue," Bustreo told The Associated Press. "But we welcome this as good news. There is hope at last for maternal health."