Why is Senegal an Exemplar?

Exemplar countries for maternal and neonatal mortality are defined as those that have demonstrated exceptional progress at reducing MMR and NMR—beyond what may be attributable to their socioeconomic progress alone. Figure 2 shows the association between NMR/MMR declines and gross national income (GNI) per capita increases across low- and middle-income countries with populations of at least 2 million that have not yet reached the MMR/NMR Sustainable Development Goal (SDG) targets. A fitted linear regression line is overlaid, indicating the expected relationship between mortality change and GNI per capita change. Countries falling below the fitted line are those that have experienced faster declines in mortality than what would be expected based on their GNI per capita increases alone.

Senegal stands out clearly as an Exemplar for its reductions in both maternal and neonatal mortality. Estimates of maternal mortality in Senegal show an average annual reduction rate (AARR) of 3.3% per year, from 553 maternal deaths per 100,000 live births in 2000 to 315 in 2017.¹ Similarly, the country’s NMR declined by an AARR of 3.1%, from 38.2 neonatal deaths per 1,000 live births in 2000 to 20.6 in 2020.² Both of these rates of reduction exceed the values for the West and Central Africa region overall, which is estimated to have experienced an AARR of 2.1% for maternal mortality and 1.8% for neonatal mortality.^1,2

Maternal mortality

In recent decades, Senegal has reduced maternal mortality at a rapid speed. As seen in Figure 3, estimates vary slightly between the Institute for Health Metrics and Evaluation (IHME) and the United Nations Maternal Mortality Estimation Inter-agency Group (UN MMEIG). UN MMEIG estimates used in analyses throughout this narrative indicate that Senegal’s MMR declined 43% between 2000 and 2017, from 553 to 315 maternal deaths per 100,000 live births.¹ Over this period, Senegal’s MMR declined at an AARR of 3.3%, outpacing the AARR for the region of West and Central Africa at 2.1%.¹

If Senegal continues at a pace of 3.3% AARR until 2030, MMR will continue to decline to 205 maternal deaths per 100,000 live births, which is short of the country’s SDG target of 140 maternal deaths per 100,000 live births—a goal set for countries with high baseline MMR values as the World Health Organization pushes for a global MMR of 70 maternal deaths per 100,000 live births by 2030. More information on Senegal’s progress toward SDGs can be found in the Benchmarking section.

Data regarding specific causes of maternal death in Senegal are generally limited, but some insight can be gained from recent efforts including the 2016 Senegal Maternal Mortality Report. While this source is not comprehensive – as over a quarter of all districts did not report information about maternal deaths and almost one quarter of all reported deaths do not specific a cause-of-death – this source nonetheless provides valuable insight to a considerable portion of maternal deaths in Senegal. Of the 421 reported maternal deaths, hemorrhage and hypertension complications were by far the largest causes of mortality, accounting for 32% and 30% of maternal deaths, respectively.³ Anemia and infection were also notable causes of death to a lesser extent, contributing 7% and 5% of reported maternal death, respectively.³

Senegal’s robust data collection system includes 11 iterations of Demographic and Health Surveys since 1992, which yield assessments of key reproductive, maternal, newborn, and child health indicators across wealth quintiles, urbanicity, and regions, among other equity dimensions. Although extensive, this data landscape does not disaggregate MMR itself by similar demographic variables or by cause because of the relative rarity of maternal death as an outcome. Collection of detailed MMR data has improved in recent years – as reflected by the insights from the 2016 Senegal Maternal Mortality Report, which includes data from Senegal’s District Health Information System. However, improved data completeness would facilitate nuanced insights that are currently only feasible for neonatal mortality and stillbirths.

Neonatal mortality

Senegal has similarly achieved substantial progress in reducing NMR, as shown by estimates from the United Nations Inter-agency Group for Child Mortality Estimation. According to these estimates, NMR has decreased steadily over the last several decades, including almost halving from 40 to 21 neonatal deaths per 1,000 live births from 1990 to 2020.² In Senegal from 2000 to 2020, NMR improvements saw an AARR of 3.1%, outpacing NMR progress in the West and Central Africa region, which experienced an AARR of 1.8% over the same period.²

Although Senegal is outpacing progress in other parts of the region, if it continues on a trajectory of a 3.1% AARR, the NMR will be 15.1 neonatal deaths per 1,000 live births, which is not far removed from the SDG target of 12. More information on Senegal’s progress toward SDGs can be found in the Benchmarking section.

The leading causes of neonatal death for Senegal in 2017 according to the World Health Organization and the Maternal and Child Epidemiology Estimation Group estimates were prematurity, birth asphyxia/trauma, and sepsis/infections, contributing 5.6, 5.3, and 4.3 neonatal deaths per 1,000 live births, respectively.⁴ Although they remain the largest causes of neonatal death in Senegal, each of these has seen dramatic reductions since 2000, especially prematurity and birth asphyxia/trauma. Between 2000 and 2017, NMR from prematurity decreased by 58.6% while NMR from birth asphyxia/trauma declined by 48.9%. Whereas these two causes constituted 62.4% of neonatal deaths in 2000, they only made up 47.9% of neonatal deaths in 2017. In contrast, congenital anomalies do not follow the trends of other neonatal causes and became slightly more common over the study period, contributing to 11.4% of neonatal deaths in 2017 compared with 4.8% in 2000.⁴

Progress in reducing neonatal mortality was not limited to any one subgroup, as NMR improved in all regions, wealth quintiles, and place of residence as shown in Figure 7.⁵ The regions of Kolda, Saint-Louis, and Diourbel in particular made large strides in reducing NMR from 2010 to 2017, with decreases of 39.5%, 30.8%, and 27.9%, respectively. The more densely populated, urban regions of Dakar and Thiès overall have lower NMR, while the more rural regions such as Kaolack and Sédhiou have higher NMR. Disparities in neonatal mortality have narrowed between urban and rural populations, with the gap decreasing from 7 to 5 neonatal deaths per 1,000 live births over the span of 2010 to 2017. By 2017, the poorest quintile reached neonatal mortality levels similar to those of other wealth quintiles, but the richest quintile still largely outpaces all other quintiles.

Stillbirths

The stillbirth rate in Senegal decreased 22.1% over the span of 2000 to 2019, from 25.3 to 19.8 stillbirths per 1,000 total births. ⁶ This stillbirth rate for West and Central Africa overall was slightly higher, at 23.4 stillbirths per 1,000 total births in 2019. Progress toward reducing stillbirth in Senegal is in line with advancements seen in West and Central Africa, with an AARR of 1.3% compared with 1.1% regionally. Although the stillbirth rate has declined slightly, the country is not currently on track to reach the Every Newborn Action Plan target of 12 stillbirths per 1,000 total births by 2030.⁷

Stillbirth rate progress in Senegal varies by region, with certain areas such as Sédhiou showing slight upticks in stillbirth rate in recent years. The regions of Kaolack and Louga have shown consistently high stillbirth rates over time, compared with regions such as Saint-Louis and Tambacounda, which have achieved relatively lower stillbirth rates. Stillbirth rates are also generally higher among lower-income women, although no wealth quintile displays particularly rapid rates of progress. Similar findings are reflected when disaggregating trends by residence, with stillbirth rates higher in rural areas than urban areas over time.