Achievement of the 2015 Millennium Development Goal 5A (Maternal Mortality) by Belize in 2011

Objective: Millennium Development Goal 5A, to decrease the maternal mortality ratio by three quarters between from 1990 to 2015, is proving difficult to achieve in many developing countries, including those in Mesoamerica. In this preliminary report from Belize we describe the major steps taken recently to improve maternal outcomes, leading to the achievement of Millennium Development Goal 5A in 2011, confounding all predictions. Methods: In mid-2007, Belize deployed the world's first integrated countrywide health information system (BHIS), with eight embedded prevention/management domains. These included one centred on maternal health and covering best practices in prenatal, intrapartum, and postpartum care. The Ministry of Health and local maternal health care leaders used ongoing BHIS maternal data aggressively to detect health care system problems and to intervene to change outcomes. The maternal mortality ratios per 100 000 live births for 2005 to 2011 (i.e., from two years before BHIS deployment to four years after) were calculated from death and live birth data using Belize vital statistics. Results: The maternal mortality ratio fell from 134.1 in 2005 to zero in 2011, with the major sustained drop occurring from 2008 onwards, coincident with implementation of the BHIS. The annual number of live births did not change over this time. Conclusion: Exceeding all expectations, Belize achieved Millennium Development Goal 5A in 2011, with a reduction in the maternal mortality ratio of well over three quarters. The drop in maternal mortality ratio was temporally associated with the introduction of the BHIS and its embedded maternal health domain. BHIS data were used aggressively to monitor and continuously improve maternal health care.