Simulation-Based Estimates and Projections of Global, Regional and Country-Level Maternal Mortality by Cause, 1990-2050

While progress has been made globally to reduce maternal deaths, measurement remains a challenge given the many causes and frequent underreporting of maternal deaths. The authors developed a structural microsimulation model of Global Maternal Health (GMatH) for 200 countries and territories using demographic, epidemiologic, clinical and health system data synthesized from the medical literature, Civil Registration Vital Statistics systems and Demographic and Health Survey data. The model was calibrated to empirical data from 1990 to 2015 and predictive accuracy was assessed by comparing projections to data from 2016 to 2020.

The model considers individual-level fertility preferences, clinical histories and incorporates data for multiple indicators along the reproductive pathway, including availability, efficacy, and effectiveness of interventions, which depend on a woman's delivery site. Outcomes include maternal deaths, live births, maternal mortality ratio (MMR), pregnancy mortality ratio, and other fertility- and process-related indicators. This structural model of women’s reproductive life cycles, based on a defined system of causal components and their relationships, synthesizes evidence on various factors from multiple sources and can offer more robust predictions than previous statistical approaches. 

Between 1990 and 2020 annual global maternal deaths declined by over 40% from 587,500 to 337,600 and are projected to decrease to 327,400 in 2030 and 320,200 in 2050. The global maternal mortality ratio was projected to decline to 167 in 2030, with 58 countries above 140, suggesting that on current trends, maternal mortality Sustainable Development Goal targets are unlikely to be met. All model parameters are described in a public website and simulation results are available on a public data repository.

Learn more:

• Briefing Paper. Simulation Modeling to Guide Priority Setting in Global Maternal Health
• Policy Analysis Paper. A Simulation-Based Comparative Effectiveness Analysis of Policies to Improve Global Maternal Health Outcomes