Abstract:
Background: Maternal mortality is a public health problem that disproportionately affects low and lower-middle
income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor
changes in this health indicator over time.
Methods: We analyzed data from women enrolled in the NICHD Global Network for Women’s and Children’s
Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within
research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and
Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and
multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal
mortality ratio (MMR, maternal deaths per 100,000 live births) over time.
Results: We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000
live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to
327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were
higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower
education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased
risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe
antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after
adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery
were associated with increased risk. We observed variable changes over time in the MMR within sites. Conclusions: The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and
delivery characteristics associated with increased risk of death, some might be confounded by indication.
Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals
target of below 70 per 100,000 live births by 2030.