Impact of scaling up health intervention coverage on reducing maternal mortality in 26 low- and middle-income countries: A modelling study

Abstract

Background: Prioritising actions is urgently needed to address the stagnation of the global maternal mortality ratio (MMR). As most maternal deaths occur in low- and middle-income countries (LMICs), we aimed to assess the impact of scaling up health intervention coverage on reducing MMR under four scenarios for 26 LMICs.

Methods: We conducted a modelling study to estimate the MMR and additional maternal lives saved by intervention by 2030 for 26 LMICs using the Lives Saved Tool (LiST). We used four scenarios to assess the impact of scaling up health intervention coverage by no scale-up (no change), modest scale-up (increased by 2% per year), substantial scale-up (increased by 5% per year), and universal coverage (coverage reached 95% by 2030). We divided the selected 26 countries into three groups according to their MMR levels in 2020.

Results: Among 26 LMICs, six (23.1%) countries showed an increase in MMRs and 13 (50.0%) stalled on the reduction of MMR from 2015 to 2020. Under a substantial scale-up of coverage or scaling up to universal coverage, the average MMR in 2030 of 26 LMICs would be 62.8 or 52.8, reaching the Sustainable Development Goal (SDG) 3.1. Caesarean delivery, uterotonics for postpartum haemorrhage, and assisted vaginal delivery had a more important role in this reduction compared to other interventions.

Conclusions: Scaling up the coverage of health interventions is critical for reducing MMRs. If a substantial scale-up or scaling up to universal coverage of continuous maternity interventions from preconception to postpartum period can be achieved, LMICs in Southeast Asia and Western Pacific regions could reach the SDG 3.1 on time.