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UN Special Rapporteur on the Right to Health Report on Mission to India - Maternal Mortality Focus.

"Registration System and Maternal Death Audits: The Special Rapporteur noted with concern that there is no effective, reliable and comprehensive civil registration for accurately reporting births and deaths in India. There is evidence that women are silently dying in childbirth and during pregnancy. As many of these deaths are not registered, they remain uncounted and unreported... It is of the utmost importance that all the circumstances of maternal deaths are examined in order to find out why the death occurred. A maternal death audit should be a non-judicial review, one that goes beyond medical reasons to identify the social, economic and cultural reasons that led or contributed to the death...."

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"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."

http://www.id21.org/zinter/id21zinter.exe?a=1&i=h8wg1g3&u=49e65c5d

Methods for Measuring Maternal Mortality in Developing Countries - Need for Data on Maternal Deaths

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 looking at inputs, outputs and processes, but it is much harder to measure impact: reduced mortality, complications and disabilities, or improved health. Challenges include getting enough reliable detail, distinguishing between maternal and other deaths, and getting large enough sample sizes. Since its launch in 1987, the Safe Motherhood Initiative has produced new opportunities and methods for data capture and analysis. A paper in BMC Medicine gives an overview of the options for policymakers who request and use information on maternal mortality.

It reports that, among the opportunities for gathering data:

• Routine methods, such as death registration, health facility statistics and censuses, yield a narrow range of information about maternal deaths.
• However, apart from censuses, they are continuously available, can provide data for small geographical units, and are relatively cost-effective. Drawbacks relate to availability, reliability, completeness and coverage.
• Special studies, such as surveys and surveillance, need more 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 than actively are more likely to miss deaths and under-represent certain population groups.
• Techniques for differentiating maternal from other deaths may involve health professionals, diagnostic tests or reports from lay people.
• Analytical approaches specific to maternal mortality 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 and development of their country. This will involve trade-offs between practical factors, such as cost, time and statistical capacity, and scientific criteria of precision, reliability, comparability and validity. The authors highlight an online guide on how to select between the options.

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

• build in-country capacity for comprehensive routine reporting of births and deaths
• challenge the view that maternal mortality is too difficult or expensive to measure
• invest in measurement strategies for maternal mortality 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, from design through to communication, including processing, analysis and interpretation of the data.

Source(s):
‘Measuring maternal mortality: an overview of opportunities and options for developing countries’, BMC Medicine 6: 12, by Wendy Graham, S. Ahmed, Cindy Stanton, Carla L. Abou-Zahr and Oona M.R. Campbell, 2008 Full document.
The Maternal Mortality Measurement Resource (MMM-R) is a web-based collection of methods, techniques and approaches for measuring maternal mortality Full document.
Immpact is a global research initiative whose aim is to promote better health for mothers to be in developing countries Full document.

Funded by: University of Aberdeen; London School of Hygiene and Tropical Medicine; Johns Hopkins University; World Health Organization; Bill & Melinda Gates Foundation; UK Department for International Development; European Commission; USAID

id21 Research Highlight: 17 January 2009

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