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In 2005 there were around 535 900 maternal deaths worldwide (Lancet 2007;370:1311–9; see also Editorial, ibid: 1283 and Comment, ibid: 1285–7 and 1291–2) giving a maternal mortality ratio of around 400 per 100 000 live births. The greatest burden (95% of the deaths) fell on sub-Saharan Africa (270 500 deaths, 50% of the total) and Asia (240 600, 45%). Between 1990 and 2005 the mean decrease in maternal mortality ratio for all countries supplying data was 2.5% per year. To achieve Millennium Development Goal 5 (MDG5) of a 75% reduction in maternal mortality ratio between 1990 and 2015 would need an average decrease of 5.5% per year. There is no evidence that maternal mortality ratios in sub-Saharan Africa have fallen since 1990. In Australia, Germany, the UK and the USA the latest reported maternal mortality ratios were 4, 4, 8 and 11 maternal deaths per 100 000 live births; in Gambia, Ghana, Burundi and Guinea Bissau the estimated corresponding figures were 690, 560, 1100 and 1100. In Brazil, Ecuador, India and Pakistan there were 110, 210, 450 and 320 maternal deaths per 100 000 live births. It is unlikely that MDG5 will be met.

In stark contrast to the gloomy global figures about …

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