Maternal mortality: measurement and causes

One of the problems in monitoring maternal mortality is lack of reliable estimates. Several studies have provided estimates of maternal mortality from pregnancy related deaths on South Africa utilizing Census and survey data but these estimates have have methodological weaknesses. This study re-examines maternal mortality from pregnancy related deaths at national and provincial levels in South Africa and provides insight into the causes of the maternal mortality deaths.

Data from the 2001 census, 2007 Community survey and death registrations were utilised. Information on household deaths including pregnancy related deaths were collected. Direct and indirect methods were utilised to estimate maternal mortality ratio.
The results indicate that maternal mortality ratio increased from around 150 per 100,000 live births in 1992-1998 to about 764 per 100,000 live births in 2007 and ranged from 102 per 100,000 live births in the Western Cape Province to 1,639 in the Eastern Cape Province in 2007. Maternal infections and parasitic diseases as well as other maternal diseases complicating pregnancy, childbirth and the peurperium are the major causes.
Despite strategies to improve maternal and child health, maternal mortality is increasing and remains a public health challenge in South Africa.

Studies on the causes of maternal mortality in India have focused on institutional deliveries, and the association of socioeconomic and demographic factors with the decline in maternal mortality has not been sufficiently investigated. By using both time series and cross-sectional data, this paper examines the factors associated with the decline in maternal mortality in India. Relative effects estimated by OLS regression analysis reveal that per capita state net domestic product (1.49611, p<0.05), poverty ratio (0.02426, p<0.05), female literacy rate (0.05905, p<0.10), infant mortality rate and total fertility rate (0.11755, p<0.05) are statistically significantly associated with the decline in the maternal mortality ratio in India. The Barro regression estimate reveals that improvements in economic and demographic conditions such as growth in state income (β=0.35020, p<0.05) and reduction in poverty (β=0.01867, p<0.01) and fertility (β=0.02598, p<0.05) have a greater association with the decline in the maternal mortality ratio in India than institutional deliveries (β=0.00305).

National statistics on maternal mortality vary considerably from international estimates: national figures for 2010 showed 5,670 maternal deaths in Latin America, substantially fewer than the 7,400 estimated by UNMMEIG or the 8,263 estimated by IHME. In Latin America, social and geographical inequality results in uneven coverage and quality of vital registration, and insufficient metadata to assess reliability. To facilitate an understanding of the methods, and to assist countries in the conciliation of national estimations with external sources, CELADE/ECLAC drafted a document comparing MMEIG, IHME and country estimates; explaining the approaches for measuring maternal mortality; and shedding light regarding interpretation of the multiple estimation sources.
Further, CELADE is working with eight pilot countries to explore data quality, assessments and adjustments. This paper reports findings of the pilot study, including a review on the coverage and quality of vital statistics; the state of the art of maternal mortality statistics at the national level; and an examination of discrepancies between sources, in the light of available metadata. Conclusions will be discussed with country stakeholders, resulting in recommendations on coordination, harmonization of figures and improvement of maternal mortality measurement.

The goal of this paper is to better appreciate how estimates of the maternal mortality ratio (MMR) are related to estimates of fertility and female reproductive age mortality and how changes in the MMR can be placed within the broader context of recent changes in fertility and adult mortality. To achieve this goal an alternative expression for the maternal mortality ratio, that incorporates measures of fertility and mortality, will be presented. This expression will also be used as a tool for comparing estimates of MMRs produced by the United Nations interagency working group with estimates from different data sources to better understand why there are large discrepancies in estimates for individual countries. Special consideration is given to the set of countries that have experienced large changes in female reproductive age mortality due to the rise in AIDS mortality.