Two Decades and Counting Since the Abuja Summit: Where Do We Stand in the Fight Against HIV/AIDS-Related Maternal Mortality?

Abstract

Background: It is more than two decades since the Organisation of African Unity's historic Abuja Summit, yet the fight against human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related maternal deaths in the region remains as critical as ever. This study examined four key dimensions to inform future actions: cross-national comparison of current HIV/AIDS-related maternal deaths, temporal trends in mortalities (for pre- and post-Abuja periods), variations across age groups and birth cohorts, and potential policy levers to drive progress.

Methods: Poisson regression-based age-period-cohort models were fitted to the Global Burden of Disease Study 2021 (GBD 2021) data (1982-2021; N = 47,750 HIV/AIDS-aggravated maternal mortalities) to estimate age, calendar period, and birth cohort effects on mortalities for each of the 54 African countries.

Results: Notable variations in HIV/AIDS-aggravated maternal deaths were observed across Africa. In 2021, 16 of the 54 countries had age-standardized mortality rates near zero, while 38 countries reported rates ranging from 0.07 to 0.95 per 100,000 women. Mortality rates rose sharply from the early 1980s, peaked during the 1990s and early 2000s, and generally declined after the Abuja Summit; however, the trajectories varied considerably across the continent. Mortality also increased with age, with substantial heterogeneity in country-level patterns. In more than two-thirds of countries, cohort comparisons relative to a 1967 baseline showed marked increases in mortalities in recent birth cohorts.

Conclusions: Given the marked variations in HIV/AIDS-aggravated maternal mortality among African populations, this study advocates for context-specific, life-course strategies to drive progress toward universal health coverage and improved maternal health across Africa.