Table 1.

The ‘obstetric transition’ phenomenon: the stages of the process to reduce maternal mortality.

Stage 1	MMR >1000
	High fertility
	Predominance of direct causes of maternal death with high rate of communicable diseases.
Stage 2	MMR 300–999
	Similar to stage 1 but greater proportion of women seeking health care.
Stage 3	MMR 50–299
	Fertility is variable and direct causes of mortality still predominate. More women start reaching health facilities.
Stage 4	MMR < 50
	Low fertility
	Important to address quality of care issues and eliminate delays within health systems.
Stage 5	MMR < 5
	Fertility very low
	Avoidable deaths are averted.

MMR: maternal mortality ratio.

Source: adapted from Souza et al.³