Not only is sub-Saharan Africa the fulcrum of maternal deaths, but most HIV-related indirect maternal deaths also occur here
Globally, 1,878 HIV-related indirect maternal deaths were recorded, of which 1,738 were in sub-Saharan Africa. Representative photo: iStock. Of the estimated 287,000 maternal deaths recorded in 2020, 70 per cent (202,000) took place in sub-Saharan Africa, according to a report by the United Nations (UN).
The maternal mortality ratio (MMR) — deaths per lakh live births — in the region was at a dangerous high of 545, many times greater than the world average of 223, the latest report on Trends in Maternal Mortality released on 23 February, 2023, showed.
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The top three sub-regions in the world with a high or very high MMR were found in sub-Saharan Africa: Western Africa at 754, middle Africa at 539 and eastern Africa at 351.
On the country level, a similar trend was seen with South Sudan (1,223), Chad (1,063) and Nigeria (1,047) recording an extremely high — greater than 1,000 — MMR.
With approximately 82,000 maternal deaths in 2020, Nigeria accounted for over a quarter (28.5 per cent) of all estimated global maternal deaths in the pandemic year.
Moreover, of the 10 countries estimated to have very high MMR in 2020 (500–999), all except one — Afghanistan — were also in sub-Saharan Africa. Only Mauritius (84), Cabo Verde (42) and Seychelles (3) in the region fell in the low MMR category (below 100).
Assessing the trend over two decades — from 2000 to 20202 — the UN report noted that declines in the MMR stagnated in sub-Saharan Africa, northern Africa, Oceania (excluding Australia and New Zealand) and western Asia, and eastern and south-eastern Asia.
The UN report highlighted another salient feature. Not only is sub-Saharan Africa the fulcrum of maternal deaths, but the maximum number of HIV-related indirect maternal deaths was also recorded here. Globally, 1,878 HIV-related indirect maternal deaths were recorded, of which 1,738 were in sub-Saharan Africa.
The report described HIV-related indirect maternal deaths as “deaths to HIV-positive women caused by the aggravating effect(s) of pregnancy on HIV; the interaction between pregnancy and HIV becomes the underlying cause of death.”
While 92.5 per cent of HIV-related indirect maternal deaths occurred in sub-Saharan Africa, Least Developed Countries (LDCs) recorded 958 in 2020.
According to the UN, LDCs are a list of 46 countries — 33 in Africa, nine in Asia, one in the Caribbean and three in the Pacific — designated so based on income levels, human assets index, which includes two sub-indices: A health sub-index and an education sub-index and economic and environmental vulnerability index.
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Only four sub-regions in the world recorded over 100 HIV-related indirect maternal deaths in 2020, all of which were in sub-Saharan Africa; eastern Africa (769), western Africa (413), middle Africa (332) and southern Africa (224). Proportion-wise, southern Africa had the highest proportion of HIV-related indirect maternal deaths as a subset of all maternal deaths, 10.3 per cent, followed by eastern Africa, 1.5 per cent.
“The effect of HIV on maternal mortality has decreased over time since the peak of the HIV epidemic in 2005: HIV-related indirect maternal deaths accounted for less than one per cent of all maternal deaths in 2020, compared with approximately two per cent in 2005,” the document noted.
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