Measuring the effect of fertility decline on the maternal mortality ratio.

This article proposes a simple method to decompose the overall decline in the maternal mortality ratio (MMR) observed between 1990 and 2008 into two components: decline attributable to fertility decline and decline attributable to safe motherhood programs. This method--illustrated here for three South Asian countries (India, Pakistan, and Bangladesh)--is aimed at helping to properly assess the impact of safe motherhood initiatives on the MMR. The methodology is also applied to estimate the 2015 MMR level implied by low, medium, and high variants of fertility decline assumed by the United Nations, and thus to assess the contribution of future fertility decline in these countries to the achievement of MDG 5 by 2015. The results show that fertility decline in these countries between 1990 and 2008 has made a substantial contribution to the reduction of the MMR and that continued fertility decline between 2008 and 2015 will contribute to the achievement of MDG 5.