Obstetric transition in the World Health Organization Multicountry Survey on Maternal and Newborn Health: Exploring pathways for maternal mortality reduction

Solange Da Cruz Chaves, José Guilherme Cecatti, Guillermo Carroli, Pisake Lumbiganon, Carol J. Hogue, Rintaro Mori, Jun Zhang, Kapila Jayaratne, Ganchimeg Togoobaatar, Cynthia Pileggi-Castro, Meghan Bohren, Joshua Peter Vogel, Özge Tunçalp, Olufemi Taiwo Oladapo, Ahmet Metin Gülmezoglu, Marleen Temmerman, João Paulo Souza

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)


Objective. To test whether the proposed features of the Obstetric Transition Model-a theoretical framework that may explain gradual changes that countries experience as they eliminate avoidable maternal mortality-are observed in a large, multicountry, maternal and perinatal health database; and to discuss the dynamic process of maternal mortality reduction using this model as a theoretical framework. Methods. This was a secondary analysis of a cross-sectional study by the World Health Organization that collected information on more than 300 000 women who delivered in 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East, during a 2-4-month period in 2010-2011. The ratios of Potentially Life-Threatening Conditions, Severe Maternal Outcomes, Maternal Near Miss, and Maternal Death were estimated and stratified by stages of obstetric transition. The characteristics of each stage are defined. Results. Data from 314 623 women showed that female fertility, indirectly estimated by parity, was higher in countries at a lower obstetric transition stage, ranging from a mean of 3 children in Stage II to 1.8 children in Stage IV. Medicalization increased with obstetric transition stage. In Stage IV, women had 2.4 times the cesarean deliveries (15.3% in Stage II and 36.7% in Stage IV) and 2.6 times the labor inductions (7.1% in Stage II and 18.8% in Stage IV) as women in Stage II. The mean age of primiparous women also increased with stage. The occurrence of uterine rupture had a decreasing trend, dropping by 5.2 times, from 178 to 34 cases per 100 000 live births, as a country transitioned from Stage II to IV. Conclusions. This analysis supports the concept of obstetric transition using multicountry data. The Obstetric Transition Model could provide justification for customizing strategies for reducing maternal mortality according to a country's stage in the obstetric transition.

Original languageEnglish
Pages (from-to)203-210
Number of pages8
JournalRevista Panamericana de Salud Publica/Pan American Journal of Public Health
Issue number4-5
Publication statusPublished - 1 Apr 2015
Externally publishedYes


  • Maternal mortality, trends
  • Maternal welfare, global health
  • Obstetrics labor complications
  • Women's health
  • World Health Organization


Dive into the research topics of 'Obstetric transition in the World Health Organization Multicountry Survey on Maternal and Newborn Health: Exploring pathways for maternal mortality reduction'. Together they form a unique fingerprint.

Cite this