Out of a total of eight Millennium Development Goals (MDG) set by the United
Nations, MDG5 aimed to improve maternal health worldwide. This was specifically
aimed at reducing childbirth-related deaths for mothers by three quarters between
1990 and 2015. The total number of maternal deaths globally has declined by 45%
from 523,000 in 1990 to 289,000 in 2013 (WHO 2014). This reduction, as an
indicator of improving maternal health globally, is a remarkable achievement. There
has however been wide variation in this improvement (WHO 2014) which needs
thorough evaluation, individually and as a cross comparison, in order to extract
constructive lessons to enhance the health of mothers, families and communities
subsequently.
This commentary focuses on Iran, identified as one of the leading countries
achieving the highest percentage reduction in maternal mortality ratios (MMR) since
1990 (WHO, 2014). Iran is a middle income country with a total population of over 76
million people, an annual population growth rate of 1.3% in 2012 and a total fertility
rate of 1.9 (World Bank, 2012). About 69% of the population is urbanised (World
Bank 2012). Iran has a controversial socioeconomic and political history, which has
implications for maternal health and mortality. The reduction in maternal mortality
has been reported to be 81% in Iran based on the 2010 World Health Organization
(WHO) report and 72% based on a more recent WHO (2014) report. The variation in
reduction is due to differences in the way the baseline maternal mortality was
calculated (WHO 2014, p20). The maternal mortality ratio (MMR) in Iran in 1990 was
estimated to have been 150 per 100,000 births in the WHO report 2010, but
estimated to have been 83 per 100,000 births in 1990 by a more recent WHO report
(2014). This variation in reported values shows the limitations of calculating maternal
mortality ratios, especially in countries with no or limited systems to accurately
record maternal deaths nationally. Even taking the more conservative estimate of
72% reduction from the most recent report (WHO, 2014), this is a considerable
achievement, placing Iran 20th in the list of countries attaining or being close to
reaching the 75% MDG5 target for reduction in maternal mortality. In this article, we
examine possible contributing factors and future developments in continuing to
reduce maternal mortality which is timely, given the need to maintain maternal and
neonatal health improvements beyond 2015 (Van Teijlingen et al 2014).