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Although rates and numbers of maternal and child deaths have decreased substantially during the past two decades, few countries are on track to achieve the declines specified in the Millennium Development Goals, a recent analysis indicates.1 Between 1990 and 2011, the global maternal mortality ratio declined by 1.9% per year and the child mortality rate by 2.2% per year- less than half the rates needed to reach the targets. At present, only 13 developing countries are on track to meet the maternal mortality goal, and just nine are expected to meet both goals.
Reductions in maternal and child mortality were among the eight goals cited in the United Nations Millennium Declaration of 2000. Specifically, the targets were for countries to reduce the mortality rate among children younger than five by two-thirds (goal 4) and the maternal mortality ratio by three-quarters (goal 5) from their 1990 levels by 2015. Two analyses published in 2010 concluded that annual declines in these outcomes were falling far short of the 4-5% needed to achieve the targets. However, the analyses were inconsistent in their classification of HIV-related maternal deaths, and did not have access to data that has since become available.
For the new analyses, investigators added 1,142 site-years of maternal mortality data, including new data from published reports and vital registration and surveillance systems; as a result, 138 of the 187 countries in the analysis have data that were unavailable for previous analyses, and the number of countries without data has been reduced from 21 to 15. In addition, unlike one of the 2010 reports, the researchers used the Millennium Development Goal definition of maternal mortality, which includes not only deaths during pregnancy or within 42 days of termination of pregnancy from direct and indirect causes, but also all HIV-related deaths that...