Malta has the world's eighth lowest rate of deaths among women during pregnancy, childbirth or up to 42 days after delivery, according to American researchers.

A study on maternal mortality in 181 countries, published in The Lancet, found that deaths among Malta's new mothers dropped dramatically between 1990 and 2008.

Malta has managed to slash its maternal mortality rate from 15 per 100,000 in 1990 to just six in 2008, one of the best ratios in the world. It had ranked in the 28th place in 1990.

There were four cases of maternal deaths in Malta between 1999, when the National Obstetric Information System started collecting figures, and 2008.

The researchers said maternal deaths globally went down by a third in the 19 years, from 526,300 in 1990 to 342,900 in 2008.

Contacted yesterday, Obstetrics and Gynaecology Department director Mark Brincat, who said every death was a tragedy, attributed the decrease in maternal deaths mainly to the higher vigilance of medical professionals. Moreover, there was now better antenatal care, accessible for free to the entire population, he added.

Prof. Brincat said that, although the general health of the population had improved over the past few years, obstetricians were dealing with mothers-to-be who were at higher risk of complications. This was due to getting pregnant at an older age and more suffering from medical conditions like diabetes.

"We have a very high standard of obstetric and medical care as well as after care, which is also very important," he said.

Prof. Brincat said investment in technology over time had also helped obstetricians to recognise problems early on and take the necessary action to save the life of mother and child.

Malta had the advantage of geography because the island's small size meant that nobody needed to cover a long distance to get to the nearest hospital.

The study shows that Italy has the lowest rate of maternal mortality, followed by Sweden, Luxembourg and Australia. Israel ranked just ahead of Malta, while Canada followed the island, the research, carried out at the Institute for Health Metrics and Evaluation at the University of Washington, found.

Afghanistan had the worst rate of maternal deaths in 2008, 1,575 per 100,000, even worse than in 1990, when 1,261 women died for every 100,000 births. The Central African Republic has the second highest rate of maternal deaths and Malawi the third. Britain ranked 23rd and the US came in at a lowly 39th place.

The researchers said the de-cline in maternal deaths around the world would have been greater without the HIV epidemic, which contributed to a substantial increase in maternal mortality in eastern and southern Africa. More than 61,000 maternal deaths in 2008 were attributed to HIV.

They said one of the most surprising results was the increase in the maternal mortality rates in the US, Canada and Norway.

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