Methods for measuring maternal mortality in developing countries

The Millennium Development Goal on maternal mortality and the shift to results-based funding of maternity services in developing countries have increased the need for data on maternal deaths. But recording who dies and their cause of death is hard for states without routine registration. What methods are on hand to policymakers wishing to estimate maternal mortality?

We can assess maternal health programmes by lookingat inputs, outputs and processes, but it is much harder to measure impact:reduced mortality, complications and disabilities, or improved health. Challengesinclude getting enough reliable detail, distinguishing between maternal andother deaths, and getting large enough sample sizes. Since its launch in 1987,the Safe Motherhood Initiative has produced new opportunities and methods fordata capture and analysis. A paper in BMC Medicine gives an overview of theoptions for policymakers who request and use information on maternal mortality.

It reports that, among the opportunities forgathering data:

• Routine methods, such as death registration, healthfacility statistics and censuses, yield a narrow range of information aboutmaternal deaths.
• However, apart from censuses, they are continuouslyavailable, can provide data for small geographical units, and are relativelycost-effective. Drawbacks relate to availability, reliability, completeness andcoverage.
• Special studies, such as surveys and surveillance, needmore resources but can give extra detailed information about the deaths.Drawbacks relate to margins of uncertainty, timeliness and predictability.
• Methods which identify deaths passively rather thanactively are more likely to miss deaths and under-represent certain populationgroups.
• Techniques for differentiating maternal from otherdeaths may involve health professionals, diagnostic testsor reports from lay people.
• Analytical approaches specific to maternalmortality are also available and use statistical methods and models to give estimates.

Universal counting of maternal deaths is the goal worldwide.In the meantime, policymakers should choose methods suited to the context anddevelopment of their country. This will involve trade-offs between practical factors,such as cost, time and statistical capacity, and scientific criteria ofprecision, reliability, comparability and validity. The authors highlight anonline guide on how to select between the options.

To encourage and enable countries to count maternaldeaths and act on the results, they recommend that policymakers should:

• build in-country capacity for comprehensive routinereporting of births and deaths
• challenge the view that maternal mortality is toodifficult or expensive to measure
• invest in measurement strategies for maternalmortality suited to the needs and resources of developing countries
• empower countries to ‘own’ their national estimates
• strengthen the skills base for all aspects of health information systems, fromdesign through to communication, including processing, analysis andinterpretation of the data.