Simulation-Based Comparative Effectiveness Analysis of Policies to Improve Global Maternal Health Outcomes

The Sustainable Development Goals include a target to reduce the global maternal mortality ratio (MMR) to less than 70 maternal deaths per 100,000 live births by 2030, with no individual country exceeding 140. However, on current trends the goals are unlikely to be met. The authors used an empirically calibrated Global Maternal Health microsimulation model, which simulates individual women in 200 countries and territories to evaluate the impact of different interventions and strategies from 2022 to 2030.

While individual interventions yielded fairly small reductions in maternal mortality, integrated strategies were more effective. A strategy to simultaneously increase facility births, improve the availability of clinical services and quality of care at facilities, and improve linkages to care would yield a projected global maternal mortality ratio (MMR) of 72 in 2030. A comprehensive strategy adding family planning and community-based interventions would have an even larger impact, with a projected MMR of 58.

The relative priority of different interventions varied by setting, highlighting the importance of considering the local context when designing and implementing policies. For example, the family planning strategy had a large impact in areas of Asia and sub-Saharan Africa where fertility is still high, but it had little impact in other areas. This occurred even within regions where there were differences in priority setting by country.

The authors emphasize that while the projected regional and country-level estimates can help guide priority setting to accelerate improvements in maternal health, country-specific contextualization and consideration of local factors, including costs, should be considered. The model could be used to formally integrate these factors for individual country analyses.

All model parameters are described on a public website and simulation results are available in a public data repository.

Learn more:

• Research Briefing. Simulation Modeling to Guide Priority Setting in Global Maternal Health
• Model Development Paper. Simulation-Based Estimates and Projections of Global, Regional and Country-Level Maternal Mortality by Cause, 1990–2050