.jpg "Maternal Mortality Ratio (MMR): A Key Health Indicator")
Maternal Mortality Ratio (MMR): A Key Health Indicator
The Maternal Mortality Ratio (MMR) is a critical health statistic used globally to measure the safety of pregnancy and childbirth. It reflects the number of women who die from pregnancy-related causes compared to the number of live births in a given period. The MMR is a key indicator for tracking progress towards global health goals, such as the Sustainable Development Goals (SDG) Target 3.1, which aims to reduce the global MMR to less than 70 per 100,000 live births by 2030.
Definition and Calculation
The Maternal Mortality Ratio is defined as:
A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
Key Aspects of the MMR
Risk Measure: The MMR depicts the risk of maternal death relative to the number of live births and essentially captures the risk of death in a single pregnancy (proxied by a single live birth).
Unit of Measure: It is always expressed as the number of maternal deaths per 100,000 live births.
Data Challenges: Accurate measurement can be challenging, particularly in low-income countries where vital registration systems are often incomplete. Estimates are often made using modeling based on various data sources, including household surveys (like Demographic and Health Surveys) and other socioeconomic information.
Global Context and Disparities
Maternal mortality remains a major global health challenge, with vast disparities between high-income and low-income regions. The vast majority of maternal deaths (nearly 95%) occur in low- and middle-income countries, and most of these deaths are preventable.
| Region/Group | Estimated Maternal Deaths (per 100,000 live births) | Key Context |
| Global (2023 Estimate) | 197 | Progress has been made, but current pace is insufficient to meet the SDG 2030 target (70). |
| Sub-Saharan Africa (2023 Estimate) | 454 | Accounted for about 70% of global maternal deaths in 2023, highlighting extreme regional inequality. |
| High-Income Countries (Approximate) | $\approx$ 11 | Lowest rates globally, demonstrating that maternal death is largely preventable with proper care. |
| Sustainable Development Goal Target (2030) | < 70 | The target to be achieved by the global community. |
Note: Data points are based on recent estimates from UN inter-agency reports (WHO, UNICEF, UNFPA, World Bank Group, and UNDESA).
Leading Causes of Maternal Death
Most maternal deaths are the result of complications that occur during pregnancy and childbirth, and the majority are preventable with effective interventions. The primary medical causes of maternal deaths worldwide include:
| Cause | Description |
| Severe bleeding (Hemorrhage) | Often occurs after childbirth (postpartum hemorrhage) and is a leading direct cause of death. |
| Hypertensive disorders | Conditions like pre-eclampsia and eclampsia (high blood pressure and organ damage). |
| Infections | Mainly sepsis following childbirth (puerperal infections). |
| Unsafe abortion | Complications from procedures performed by untrained individuals or in unhygienic environments. |
| Indirect causes | Deaths resulting from pre-existing medical conditions (like heart disease or HIV) that are aggravated by the physiological stress of pregnancy. |
Addressing the Delays
The framework for preventing maternal mortality often focuses on the "Three Delays" that prevent women from receiving timely, quality care:
Delay in deciding to seek care: Influenced by socioeconomic, cultural, and educational factors.
Delay in reaching a health facility: Caused by distance, lack of transportation, or poor roads.
Delay in receiving adequate care at the facility: Due to staff shortages, lack of supplies, or poor quality of care.
Reducing the MMR requires comprehensive efforts across the entire health system, focusing on access to skilled birth attendants, emergency obstetric care, family planning, and improved quality of health services.
.jpg "Countries with the Lowest Maternal Mortality Rati")
Countries with the Lowest Maternal Mortality Rati
The Maternal Mortality Ratio (MMR) is a crucial global health indicator, representing the number of maternal deaths per 100,000 live births. It reflects the overall quality of a country's healthcare system, particularly access to skilled birth attendance and comprehensive emergency obstetric care. A low MMR signifies strong maternal health policies and successful implementation of essential healthcare services.
Global Landscape of Maternal Health
Globally, there's been significant progress in reducing maternal mortality, but major disparities persist. High-income nations generally have very low MMRs, often in the single digits, due to universal access to high-quality healthcare, advanced medical technology, and robust public health infrastructure. In contrast, most maternal deaths occur in low- and middle-income countries, particularly in Sub-Saharan Africa and Southern Asia, highlighting the critical need for continued global health investment and resource allocation.
The goal set by the Sustainable Development Goals (SDG 3.1) is to reduce the global MMR to less than 70 per 100,000 live births by 2030.
Top Performers: Countries with the Lowest MMR
The following table lists countries and territories with some of the lowest modeled maternal mortality ratios globally. These figures, typically modeled estimates from international organizations like the World Health Organization (WHO), UNICEF, and the World Bank, are subject to slight variations based on the reporting source and methodology. The data below is based on recent estimates, illustrating countries that have achieved exceptional levels of maternal safety.
| Rank | Country/Territory | Maternal Mortality Ratio (MMR) (deaths per 100,000 live births) | Date of Estimate |
| 1 | Belarus | 1 | 2023 |
| 2 | Australia | 2 | 2023 |
| 3 | Croatia | 3 | 2023 |
| 3 | Czechia (Czech Republic) | 3 | 2023 |
| 5 | Belgium | 4 | 2023 |
| 5 | Denmark | 4 | 2023 |
| 5 | Germany | 4 | 2023 |
| 8 | Estonia | 5 | 2023 |
| 8 | Greece | 5 | 2023 |
| 10 | Austria | 6 | 2023 |
| 10 | Bosnia and Herzegovina | 6 | 2023 |
| 10 | Bulgaria | 6 | 2023 |
| 13 | Albania | 7 | 2023 |
| 13 | France | 7 | 2023 |
| 15 | Finland | 8 | 2023 |
| 15 | Iceland | 8 | 2023 |
| 17 | New Zealand | 9 | 2023 |
| 18 | Chile | 10 | 2023 |
Source: World Bank, CIA World Factbook, and related international estimates (MMR modeled estimates, per 100,000 live births).
Factors Contributing to Low MMR
Countries that achieve and maintain a low MMR typically share several key characteristics and investments in their health systems:
Universal Access to Care: Ensuring that all pregnant women, regardless of socioeconomic status, have access to prenatal care, skilled assistance during childbirth, and postpartum follow-up.
Strong Primary Healthcare: A well-funded and accessible primary care system forms the foundation, allowing for early detection and management of pregnancy-related complications.
High Rate of Skilled Birth Attendance: Having births attended by trained health professionals (doctors, nurses, or midwives) in a medical facility is critical for managing obstetric emergencies.
Functioning Emergency Obstetric Care: Access to services for managing complications like hemorrhage and pre-eclampsia, including blood transfusions and emergency C-sections, is a life-saving necessity.
Comprehensive Health Education: Public health campaigns and education about reproductive health, family planning, and recognizing danger signs during pregnancy empower women to seek timely care.
These examples show that a nation's commitment to public health and equitable healthcare access is the primary determinant of maternal well-being.
.jpg "Belarus: A Global Leader in Maternal Health Safety")
Belarus: A Global Leader in Maternal Health Safety
Belarus has distinguished itself as one of the world's most successful countries in safeguarding the lives of mothers during and after childbirth. With a Maternal Mortality Ratio (MMR) that rivals the best healthcare systems globally, the country serves as a key example of how targeted government policy and strategic health system reforms can dramatically improve public health outcomes.
The MMR is defined as the number of maternal deaths per 100,000 live births. Belarus's remarkably low figure places it on par with, or even ahead of, many high-income Western nations, demonstrating a profound commitment to maternal and child welfare.
Maternal Mortality Ratio in Belarus (MMR Trend)
The following table highlights the substantial progress Belarus has made in reducing its MMR over the past two decades, showcasing its journey to becoming a top global performer.
| Year | Maternal Mortality Ratio (deaths per 100,000 live births) |
| 2000 | 24 |
| 2010 | 3 |
| 2020 | 1 |
| 2023 (Modeled Estimate) | 1 |
Source: WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division Estimates.
The Pillars of Belarus's Success
Belarus's achievement in maternal health is not accidental; it is the result of a coordinated, comprehensive, and well-funded national strategy. Key elements of this success include:
Multileveled Perinatal Care System:
Since 2005, the government implemented a tiered system that concentrates specialized services in designated centers for high-risk pregnancies, while low-risk cases are managed at local and regional facilities. This ensures that the most complex and critical cases receive care from highly-trained specialists and state-of-the-art equipment.
Universal and Early Prenatal Care:
The national health system provides free, high-quality prenatal care to virtually all pregnant women (over 98% coverage).
Financial incentives are offered to expectant mothers who enroll in prenatal care within the first 12 weeks of pregnancy, drastically increasing early access and adherence to medical advice.
High Rate of Skilled Birth Attendance:
Almost all births in Belarus (over 99%) are attended by skilled health personnel (obstetricians, gynecologists, and midwives) in a medical facility. This drastically reduces complications that might arise during labor and ensures immediate emergency intervention if required.
Specialization and Training:
The Ministry of Health has made significant investments in training and deploying a large number of obstetrician-gynecologists and specialized healthcare workers, ensuring a high level of clinical expertise across the country.
The establishment of Republican Scientific and Practical Centres provides a focus for highly-specialized care, research, and the adoption of the latest medical technologies, such as advanced genetic diagnostics and neonatal surgery.
Focus on Prevention:
Proactive programs have successfully eliminated mother-to-child transmission of both HIV and syphilis, demonstrating an integrated approach to maternal health that goes beyond obstetric care.
Belarus's journey from a post-Soviet health system to a global leader in maternal safety demonstrates the profound impact that sustained political commitment, strategic investment in healthcare infrastructure, and a focus on equitable access to skilled care can have on saving mothers' lives.
.jpg "Australia's Maternal Mortality Ratio: A Snapshot of High-Quality Care")
Australia's Maternal Mortality Ratio: A Snapshot of High-Quality Care
Australia consistently maintains one of the lowest maternal mortality ratios (MMR) in the world, a testament to its robust healthcare system, high rate of births attended by skilled health personnel, and continuous monitoring of maternal health outcomes. Maternal mortality ratio is defined as the number of women who die from pregnancy-related causes while pregnant or within 42 days of the end of pregnancy, per 100,000 live births.
Recent Trends in Australia's Maternal Mortality Ratio
While maternal death is a rare event in Australia, its ratio remains a crucial indicator of the health system's effectiveness and equity. Official reports aggregate data over several years to allow for more detailed and meaningful analysis due to the small numbers involved.
| Reporting Period | Maternal Mortality Ratio (Deaths per 100,000 Women Giving Birth) |
| 1973–1975 | 12.7 |
| 2018–2020 | 5.6 |
| 2021–2022 | 5.3 |
| 2022 | 4.8 |
Note: Data points may be based on slightly different methodologies or data collections (e.g., number of live births vs. women giving birth), but all indicate a significant, long-term decline.
The decline from a ratio of $12.7$ in the early 1970s to recent figures below $6$ highlights major advancements in obstetrics, public health, and general population health. The 2018–2020 ratio of $5.6$ was one of the lowest recorded since comparable definitions were introduced.
Key Factors Contributing to Australia's Low MMR
The country's success in maintaining a low MMR is attributable to several integrated aspects of its healthcare system and society:
Universal Healthcare (Medicare): Australia's public health insurance system, Medicare, provides free treatment in public hospitals and subsidises out-of-hospital treatment, ensuring high-quality maternity care is accessible to the vast majority of the population.
Skilled Birth Attendance: Virtually all births in Australia ($99\%$ of births, according to WHO data) are attended by skilled health professionals (midwives, doctors, or nurses), ensuring timely management of complications.
Comprehensive Maternity Care Models: Women have various care options, including public hospital care, private obstetrician care, shared care with a General Practitioner (GP), and midwifery continuity of care models (like Midwifery Group Practice). These options are designed to provide appropriate care pathways for both low-risk and complex pregnancies.
Continuous Surveillance and Reporting: The National Maternal Mortality Data Collection, primarily run by the Australian Institute of Health and Welfare (AIHW), provides ongoing, in-depth surveillance. This reporting is essential for identifying risk factors and professional care failures that contribute to maternal deaths, allowing for targeted policy and practice improvements.
Disparities and Areas for Improvement
Despite the overall excellent results, significant disparities exist within Australia that require ongoing attention:
Aboriginal and Torres Strait Islander Women: The MMR for Aboriginal and Torres Strait Islander women remains disproportionately higher than for non-Indigenous Australian women. For example, in 2018–2020, their ratio was $9.4$ per 100,000 women giving birth. This disparity is often linked to social determinants of health, poorer access to culturally safe care, and higher rates of pre-existing health conditions.
Older Women and Women with Co-morbidities: Women aged 35 and over, and those with pre-existing medical conditions (such as cardiovascular disease, the leading cause of maternal death), face a higher risk.
Socioeconomic Disadvantage: Women in the lowest socioeconomic groups are also identified as being at higher risk of severe maternal morbidity and mortality.
Efforts to further reduce the MMR focus on addressing these inequalities, improving cultural safety in health services, and enhancing care pathways for high-risk women.
.jpg "Maternal Mortality Ratio in Croatia: A Snapshot of Maternal Health")
Maternal Mortality Ratio in Croatia: A Snapshot of Maternal Health
Croatia, a European Union member state, generally maintains a very low Maternal Mortality Ratio (MMR), aligning it with other high-income nations and reflecting a well-developed healthcare system. The MMR is a critical public health indicator, representing the number of maternal deaths per 100,000 live births. Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
Overview of Trends
Historically, Croatia has seen its MMR fluctuate but generally remain in the single digits, indicating a strong performance in maternal health and safety. The country's commitment to providing near-universal skilled birth attendance—with rates typically near 100%—is a major contributing factor to its low maternal mortality.
While the figures are low, year-to-year variations are to be expected, especially in countries with small overall numbers of maternal deaths. A single maternal death can significantly impact the MMR for that year. The overall trend, however, shows Croatia as a country where the risk of maternal death is exceptionally low.
Maternal Mortality Ratio (MMR) in Croatia (Modeled Estimates)
The table below presents recent modeled estimates for the Maternal Mortality Ratio (MMR) in Croatia, as reported by international organizations such as the WHO, UNICEF, UNFPA, and the World Bank Group.
| Year | Maternal Mortality Ratio (Per 100,000 Live Births) |
| 2023 | 3 |
| 2022 | 6 |
| 2021 | 12 |
| 2020 | 5 |
| 2019 | 4 |
| 2018 | 3 |
| 2017 | 4 |
| 2016 | 4 |
| 2015 | 4 |
| 2010 | 6 |
| 2005 | 7 |
| 2000 | 8 |
Note: Data points are modeled estimates and can vary slightly between sources and publications, especially for recent years. The MMR is subject to variation due to the small total number of maternal deaths.
Key Factors in Croatia's Low MMR
Croatia's low MMR is a result of several key aspects of its healthcare system:
Universal Access to Care: Croatia provides widespread access to antenatal, delivery, and postnatal care through its public health system.
Skilled Birth Attendance: Virtually all births in Croatia are attended by skilled health personnel (doctors, nurses, or midwives), which is a critical measure for preventing maternal and neonatal deaths.
Comprehensive Protocols: National guidelines and policies are in place for essential maternal and newborn care, including systems for reviewing maternal deaths.
High-Income Status: As a high-income country, Croatia has the resources and infrastructure to support advanced medical intervention and emergency obstetric care, which are vital for reducing severe maternal complications.
In conclusion, Croatia ranks among the safest countries in the world for childbirth, with its consistently low Maternal Mortality Ratio demonstrating a high standard of maternal healthcare.
.jpg "Czechia (Czech Republic): Maternal Mortality Ratio")
Czechia (Czech Republic): Maternal Mortality Ratio
The Czech Republic, often referred to as Czechia, is consistently recognized for having one of the lowest maternal mortality ratios (MMR) globally. This low rate is indicative of a highly developed healthcare system, universal access to high-quality maternal care, and effective public health strategies.
The maternal mortality ratio is defined as the number of women who die from pregnancy-related causes while pregnant or within 42 days of the termination of pregnancy, per 100,000 live births. The country's successful reduction and maintenance of a very low MMR demonstrate its strong commitment to maternal health, aligning it with other high-income European nations.
Key Trends and Statistics
Recent data from international health organizations highlights the Czech Republic's exceptional performance in maternal health.
Low and Stable Rate: The MMR in Czechia has remained consistently low, often reported in the single digits, reflecting a stable and effective healthcare system.
Significant Improvement: Over the long term, the country has achieved a substantial reduction in maternal deaths, moving from higher rates in the early 2000s to its current low level.
Comparison: The rate is significantly better than the global average and compares favorably to its regional and income group averages.
Maternal Mortality Ratio in Czechia (Czech Republic)
The following table presents the modeled estimates for the Maternal Mortality Ratio (MMR) in Czechia for selected years, illustrating the trend of low maternal mortality.
| Year | Maternal Mortality Ratio (per 100,000 live births) |
| 2000 | 15 |
| 2010 | 7 |
| 2015 | 3 |
| 2020 | 3 |
| 2023 | 3 |
Source: World Health Organization (WHO), UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division modeled estimates.
Factors Contributing to Low MMR
Several elements contribute to Czechia's positive maternal health outcomes:
Universal Healthcare: The Czech healthcare system is based on universal access, ensuring that all pregnant women receive necessary prenatal, delivery, and postnatal care regardless of their socioeconomic status.
High-Quality Obstetric Care: The country has a high standard of care in obstetrics and gynecology, with virtually all births attended by skilled health personnel in well-equipped facilities.
Comprehensive Prenatal Screening: Routine and comprehensive prenatal care, including screenings and monitoring for high-risk pregnancies, allows for early detection and management of potential complications.
Effective Monitoring and Data Collection: The consistent and low reported rates suggest a robust system for tracking maternal deaths, which is crucial for quality improvement and targeted interventions.
In conclusion, the Czech Republic stands as an example of a nation that has successfully tackled the challenge of maternal mortality, achieving a rate that is among the best in the world.
.jpg "Maternal Mortality Ratio in Belgium")
Maternal Mortality Ratio in Belgium 🇧🇪
The maternal mortality ratio (MMR) in Belgium is a key indicator of the safety of pregnancy and childbirth in the country. Recent data shows a ratio that is low by global standards but has seen an increase in recent years, largely due to a change in the classification and surveillance methods.
The Maternal Mortality Ratio (MMR) for Belgium is often reported in five-year averages by national statistical offices (Statbel) and international organizations (WHO, UNICEF).
Here is a table presenting recent estimates, which reflects different methodologies (Statbel's national data vs. UN-agency modeled estimates).
| Period / Year | Maternal Mortality Ratio (per 100,000 live births) | Source / Notes |
| 2018–2022 (5-year average) | 8.8 | Statbel (National Data, following WHO-recommended ICD-MM since 2018) |
| 2017–2021 (5-year average) | 7.6 | Statbel (National Data, using WHO-recommended ICD-MM) |
| 2013–2017 (5-year average) | 4.1 | Statbel (National Data, using previous methodology) |
| 2020 (Modeled Estimate) | 4.8 | UN Inter-agency Estimates (WHO, UNICEF, etc.) |
| 2000 (Modeled Estimate) | 8.3 | UN Inter-agency Estimates (WHO, UNICEF, etc.) |
Note on Data:
The upward trend in the Statbel figures since 2018 (from 4.1 to 8.8) is largely attributed to a change in methodology, where Belgium began applying the WHO's recommended classification for maternal deaths (ICD-MM), which includes a broader definition, such as some indirect and undetermined causes like suicide.
International organizations (like WHO/UNICEF) often use modeled estimates to ensure comparability across countries and years, which may differ from a country's official national data.
Current Maternal Mortality Ratio
According to data from Statbel (the Belgian statistical office), the most recently published maternal mortality ratio for Belgium, spanning the five-year period centered on 2020 (2018–2022), is:
8.8 maternal deaths per 100,000 live births 🔢
This ratio represents the number of direct and indirect maternal deaths that occur during pregnancy or within 42 days of the end of the pregnancy, per 100,000 live births.
Factors Influencing the Recent Increase
The increase in the reported MMR from the preceding period (e.g., 4.1 per 100,000 live births for 2013-2017) is primarily attributed to improvements in data collection and a change in the definition used, rather than a significant deterioration in care.
1. Change in Definition and Surveillance
WHO's ICD-10 Classification: Since 2018, Statbel has adopted the World Health Organization's (WHO) updated International Classification of Diseases for Maternal Mortality (ICD-MM) methodology.
Inclusion of Suicide: A key change is the systematic inclusion of cases such as suicide, which, if related to or aggravated by pregnancy or its management within 42 days postpartum, are now counted as a cause of maternal death. Suicides and circulatory diseases each account for around 10% of cases in recent analysis periods.
BAMM System: The establishment of the Belgian Analysis system for Maternal Mortality (BAMM), a structured and confidential registration and analysis system, complements the official statistics from death certificates, providing a more comprehensive and accurate picture of the true maternal mortality burden, similar to systems in neighboring countries.
2. Leading Causes of Maternal Death
For the period analyzed, the causes of maternal death directly related to pregnancy, childbirth, and the puerperium account for about a third of all cases. Within this category, the most frequent causes include:
Obstetric embolism
Complications during labor and delivery
Postpartum complications
International Context
As a highly-developed Western European nation, Belgium's maternal mortality ratio remains very low compared to the global average (which was 197 deaths per 100,000 live births in 2023, according to WHO estimates).
The Belgian ratio is generally comparable to that of other countries in the European Union, which also face challenges in accurately and uniformly reporting maternal deaths, often leading to fluctuations in reported rates. The move to more rigorous surveillance systems like BAMM is a common trend across Europe aimed at improving the quality of data to inform healthcare strategies and ultimately reduce avoidable deaths.
.jpg "country With lower Maternal Mortality Ratio (MMR)")
Conclusion: The Blueprint for Safe Motherhood
The analysis of maternal mortality ratios (MMR) reveals a stark global contrast: while many developing nations grapple with rates in the hundreds, countries in the developed world, particularly in Northern Europe and Oceania, have successfully driven their MMR down to the low single digits (e.g., Norway, Denmark, Iceland, and Australia often report rates below 5 per 100,000 live births). This dramatic difference is not a matter of chance, but a reflection of systemic commitment to maternal health.
The lesson from the countries with the lowest MMR is clear: a low maternal death rate is achieved through a multi-faceted, equitable, and resilient health system, underpinned by universal social support.
Key Takeaways from the Lowest-MMR Nations
Universal, Integrated Healthcare: The foundation is universal health coverage that provides comprehensive, zero- or low-cost maternal care, including preconception, antenatal, delivery (with skilled birth attendants), and high-quality postpartum care. This eliminates the financial barriers that often lead to delayed or forgone care.
Emphasis on Midwifery and Quality of Care: These countries rely heavily on a well-trained, integrated midwifery workforce as the backbone of routine maternity services. Crucially, their systems also ensure immediate, effective referral pathways to emergency obstetric care when complications arise, minimizing the impact of the "three delays" (delay in seeking care, reaching care, and receiving care).
Data-Driven Review and Accountability: Systems in these nations employ enhanced surveillance and confidential enquiry into every maternal death. This process moves beyond simply recording a cause of death to meticulously identifying systemic failures and implementing corrective actions, fostering a culture of continuous improvement in patient safety.
Robust Social Safety Nets: Low MMR is intrinsically linked to robust social equity and support. Policies such as guaranteed paid maternity leave, comprehensive parental support programs, and strong anti-poverty measures ensure that the social and economic stress factors that contribute to poor maternal health outcomes are mitigated.
Ultimately, the exceptional safety of childbirth in these leading countries is a direct result of prioritizing the health of every woman and establishing a non-negotiable standard of care. For the global community to meet the Sustainable Development Goal (SDG) target of reducing the global MMR, it must look to these nations not just for aspirational goals, but for a practical blueprint of committed political will, universal access, and uncompromising quality in maternal healthcare.