Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
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Johan
Arnlöv
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Valentina S Arsic
Arsenijevic
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Ali
Artaman
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Majed Masoud
Asad
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Rana J
Asghar
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Reza
Assadi
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Lydia S
Atkins
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Alaa
Badawi
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Kalpana
Balakrishnan
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Arindam
Basu
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Sanjay
Basu
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Justin
Beardsley
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Neeraj
Bedi
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Tolesa
Bekele
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Michelle L
Bell
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Eduardo
Bernabe
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Tariku J
Beyene
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Zulfiqar
Bhutta
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Aref
Bin Abdulhak
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Jed D
Blore
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Berrak Bora
Basara
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Dipan
Bose
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Nicholas
Breitborde
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Rosario
Cárdenas
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Carlos A
Castañeda-Orjuela
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Ruben Estanislao
Castro
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Ferrán
Catalá-López
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Alanur
Cavlin
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Jung-Chen
Chang
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Xuan
Che
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Costas A
Christophi
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Sumeet S
Chugh
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Massimo
Cirillo
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Samantha M
Colquhoun
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Leslie Trumbull
Cooper
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Cyrus
Cooper
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Iuri
da Costa Leite
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Lalit
Dandona
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Rakhi
Dandona
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Adrian
Davis
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Anand
Dayama
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Louisa
Degenhardt
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Diego
De Leo
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Borja
del Pozo-Cruz
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Kebede
Deribe
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Muluken
Dessalegn
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Gabrielle A
deVeber
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Samath D
Dharmaratne
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Uğur
Dilmen
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Eric L
Ding
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Rob E
Dorrington
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Tim R
Driscoll
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Sergei Petrovich
Ermakov
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Alireza
Esteghamati
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Emerito Jose A
Faraon
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Farshad
Farzadfar
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Manuela Mendonca
Felicio
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Seyed-Mohammad
Fereshtehnejad
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Graça Maria Ferreira
de Lima
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Mohammad H
Forouzanfar
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Elisabeth B
França
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Lynne
Gaffikin
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Ketevan
Gambashidze
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Fortuné Gbètoho
Gankpé
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Ana C
Garcia
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Johanna M
Geleijnse
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Katherine B
Gibney
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Maurice
Giroud
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Elizabeth L
Glaser
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Ketevan
Goginashvili
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Philimon
Gona
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Dinorah
González-Castell
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Atsushi
Goto
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Hebe N
Gouda
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Harish Chander
Gugnani
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Rahul
Gupta
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Rajeev
Gupta
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Nima
Hafezi-Nejad
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Randah Ribhi
Hamadeh
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Mouhanad
Hammami
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Graeme J
Hankey
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Hilda L
Harb
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Rasmus
Havmoeller
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Simon I
Hay
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Ileana B Heredia
Pi
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Hans W
Hoek
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H Dean
Hosgood
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Damian G
Hoy
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Abdullatif
Husseini
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Bulat T
Idrisov
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Kaire
Innos
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Manami
Inoue
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Kathryn H
Jacobsen
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Eiman
Jahangir
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Sun Ha
Jee
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Paul N
Jensen
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Vivekanand
Jha
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Guohong
Jiang
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Jost B
Jonas
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Knud
Juel
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Edmond Kato
Kabagambe
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Haidong
Kan
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Nadim E
Karam
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André
Karch
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Corine Kakizi
Karema
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Anil
Kaul
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Norito
Kawakami
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Konstantin
Kazanjan
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Dhruv S
Kazi
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Andrew H
Kemp
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Andre Pascal
Kengne
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Maia
Kereselidze
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Yousef Saleh
Khader
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Shams Eldin Ali Hassan
Khalifa
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Ejaz Ahmed
Khan
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Young-Ho
Khang
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Luke
Knibbs
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Yoshihiro
Kokubo
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Soewarta
Kosen
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Barthelemy Kuate
Defo
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Chanda
Kulkarni
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Veena S
Kulkarni
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G Anil
Kumar
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Kaushalendra
Kumar
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Ravi B
Kumar
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Gene
Kwan
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Taavi
Lai
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Ratilal
Lalloo
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Hilton
Lam
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Van C
Lansingh
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Anders
Larsson
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Jong-Tae
Lee
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James
Leigh
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Mall
Leinsalu
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Ricky
Leung
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Xiaohong
Li
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Yichong
Li
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Yongmei
Li
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Juan
Liang
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Xiaofeng
Liang
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Stephen S
Lim
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Hsien-Ho
Lin
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Steven E
Lipshultz
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Shiwei
Liu
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Yang
Liu
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Belinda K
Lloyd
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Stephanie J
London
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Paulo A
Lotufo
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Jixiang
Ma
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Stefan
Ma
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Vasco Manuel Pedro
Machado
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Nana Kwaku
Mainoo
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Marek
Majdan
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Christopher Chabila
Mapoma
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Wagner
Marcenes
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Melvin Barrientos
Marzan
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Amanda J
Mason-Jones
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Man Mohan
Mehndiratta
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Fabiola
Mejia-Rodriguez
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Ziad A
Memish
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Walter
Mendoza
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Ted R
Miller
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Edward J
Mills
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Ali H
Mokdad
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Glen Liddell
Mola
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Lorenzo
Monasta
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Jonathan
de la Cruz Monis
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Julio Cesar Montañez
Hernandez
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Ami R
Moore
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Maziar
Moradi-Lakeh
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Rintaro
Mori
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Ulrich O
Mueller
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Mitsuru
Mukaigawara
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Aliya
Naheed
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Kovin S
Naidoo
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Devina
Nand
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Vinay
Nangia
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Denis
Nash
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Chakib
Nejjari
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Robert G
Nelson
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Sudan Prasad
Neupane
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Charles R
Newton
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Marie
Ng
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Mark J
Nieuwenhuijsen
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Muhammad Imran
Nisar
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Sandra
Nolte
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Ole F
Norheim
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Luke
Nyakarahuka
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In-Hwan
Oh
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Takayoshi
Ohkubo
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Bolajoko O
Olusanya
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Saad B
Omer
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John Nelson
Opio
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Orish Ebere
Orisakwe
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Jeyaraj D
Pandian
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Christina
Papachristou
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Jae-Hyun
Park
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Angel J Paternina
Caicedo
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Scott B
Patten
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Vinod K
Paul
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Boris Igor
Pavlin
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Neil
Pearce
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David M
Pereira
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Konrad
Pesudovs
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Max
Petzold
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Dan
Poenaru
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Guilherme V
Polanczyk
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Suzanne
Polinder
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Dan
Pope
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Farshad
Pourmalek
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Dima
Qato
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D Alex
Quistberg
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Anwar
Rafay
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Kazem
Rahimi
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Vafa
Rahimi-Movaghar
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Sajjad
ur Rahman
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Murugesan
Raju
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Saleem M
Rana
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Amany
Refaat
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Luca
Ronfani
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Nobhojit
Roy
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Tania Georgina Sánchez
Pimienta
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Mohammad Ali
Sahraian
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Joshua A
Salomon
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Uchechukwu
Sampson
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Itamar S
Santos
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Monika
Sawhney
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Felix
Sayinzoga
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Ione JC
Schneider
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Austin
Schumacher
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David C
Schwebel
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Soraya
Seedat
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Sadaf G
Sepanlou
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Edson E
Servan-Mori
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Marina
Shakh-Nazarova
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Sara
Sheikhbahaei
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Kenji
Shibuya
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Hwashin Hyun
Shin
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Ivy
Shiue
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Inga Dora
Sigfusdottir
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Donald H
Silberberg
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Andrea P
Silva
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Jasvinder A
Singh
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Vegard
Skirbekk
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Karen
Sliwa
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Sergey S
Soshnikov
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Luciano A
Sposato
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Chandrashekhar T
Sreeramareddy
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Konstantinos
Stroumpoulis
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Lela
Sturua
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Bryan L
Sykes
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Karen M
Tabb
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Roberto Tchio
Talongwa
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Feng
Tan
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Carolina Maria
Teixeira
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Eric Yeboah
Tenkorang
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Abdullah Sulieman
Terkawi
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Andrew L
Thorne-Lyman
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David L
Tirschwell
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Jeffrey A
Towbin
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Bach X
Tran
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Miltiadis
Tsilimbaris
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Uche S
Uchendu
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Kingsley N
Ukwaja
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Eduardo A
Undurraga
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Selen Begüm
Uzun
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Andrew J
Vallely
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Coen H
van Gool
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Tommi J
Vasankari
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Monica S
Vavilala
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N
Venketasubramanian
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Salvador
Villalpando
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Francesco S
Violante
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Vasiliy Victorovich
Vlassov
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Theo
Vos
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Stephen
Waller
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Haidong
Wang
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Linhong
Wang
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XiaoRong
Wang
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Yanping
Wang
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Scott
Weichenthal
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Elisabete
Weiderpass
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Robert G
Weintraub
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Ronny
Westerman
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James D
Wilkinson
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Solomon Meseret
Woldeyohannes
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John Q
Wong
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Muluemebet Abera
Wordofa
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Gelin
Xu
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Yang C
Yang
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Yuichiro
Yano
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Gokalp Kadri
Yentur
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Paul
Yip
;
Naohiro
Yonemoto
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Seok-Jun
Yoon
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Mustafa Z
Younis
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Chuanhua
Yu
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Kim Yun
Jin
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Maysaa
El Sayed Zaki
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Yong
Zhao
;
Yingfeng
Zheng
;
Maigeng
Zhou
;
Jun
Zhu
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Xiao Nong
Zou
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Alan D
Lopez
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Mohsen
Naghavi
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Christopher JL
Murray
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Rafael
Lozano
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(2014)
Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
Lancet, 384 (9947).
pp. 980-1004.
ISSN 0140-6736
DOI: 10.1016/S0140-6736(14)60696-6
BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. FUNDING: Bill & Melinda Gates Foundation.