Maternal Mortality

MICS3 Data Analysis and Report Writing

Background

• The complications of pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries.

• Women whose growth has been stunted by chronic malnutrition are vulnerable to obstructed labour. Anaemia predisposes women to haemorrhage and sepsis during delivery. And maternal risk is even greater for women who have undergone female genital mutilation.

Background

• Causes of maternal mortality include post-partum haemorrhage, sepsis, complications of unsafe abortion, prolonged or obstructed labour and the hypertensive disorders of pregnancy, especially eclampsia.

• Prompt access to quality obstetric services equipped to provide lifesaving drugs, antibiotics and transfusions and to perform the caesarean sections and other surgical interventions that prevent deaths from obstructed labour, eclampsia and intractable haemorrhage is needed.

International Goals & Targets

Between 1990 and 2015

reduce by three-quarters the

maternal mortality ratio

Reduction in the maternal mortality

ratio by at least one-third, in pursuit of the MDG of reducing it by

three-quarters by 2015

Definition of Indicator

Maternal mortality ratio

Numerator: Number of deaths of women from pregnancy-related causes in a given year

Denominator: Number of live births in a given year (expressed per 100,000 live births)

Methodological Issues

Sources of data for maternal mortality

• Vital Registration systems

• Reproductive Age Mortality Studies (RAMOS)

• Household Surveys- Direct Methods- Sisterhood methods

- Direct- Indirect

Methodological Issues

Definition of a maternal death

Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

Methodological Issues

Problems in measuring maternal mortality

Requires information on:

• Pregnancy status

• Timing of death (within 42 days of termination of

pregnancy)

• Cause of death

Each of these elements is difficult to measure!

Methodological Issues

Problems in measuring maternal mortality

Vital registration systems:• Underreporting• Misclassification

In most developed countries with complete vital registration, misclassification and underreporting, causes estimates to be underreported by a factor between 1.5 and 3.

Methodological Issues

Problems with measurement

Household Surveys:• Maternal mortality is a relatively rare event • When household surveys are used, huge sample sizes are required

Example:To estimate an MMR of 300 within a 20% margin of error requires a sample of 50,000 births (may imply much larger number of households)

Methodological Issues

Sisterhood Method (indirect)

Advantages• Reduces sample size requirements• Minimal data requirements (5 questions only)• Simple data processing and analysis

Disadvantages• Results reflect a point in time approximately 12

years before the survey

• Wide confidence intervals – cannot be used to measure trends in the short term

Methodological Issues

Sisterhood Method (indirect)

• How many sisters (born to the same mother) have you ever had?

• How many of these sisters ever reached age 15?

• How many of these sisters (who are at least 15 years old) are alive now?

• How many of these sisters who reached age 15 or more have died?

• How many of these dead sisters died while they were pregnant, or during childbirth, or during the six weeks after the end of pregnancy?

Methodological Issues

Eligibility for Sisterhood Method (indirect)

• If there is no reliable estimate for maternal mortality

• If an approximate level of maternal mortality is needed for advocacy purposes and to draw attention to the problem

• Remember: Because of large confidence intervals around the estimates, the results are not suitable for assessing trends over time.

Methodological Issues

MMR = 100,000 [1 – (1 – LRMD) exp 1/ TFR]

where,

LRMD is the lifetime risk of maternal death

TFR is the total fertility rate estimated for the 10-14 years prior to the survey

Methodological Issues

• The adjustment factors are standard and reflect, for each age group, the proportion of women’s reproductive life exposed to the risk of maternal mortality

• Sisters aged 15+ for the first three age groups are adjusted to be equal to the number of respondents in the age group times the average number of sisters to respondents aged 30+

Tabulation Plan

Table RH.6: Maternal Mortality Ratio

Regional Maternal Mortality

Maternal Mortality

440

64

110

190

220

560

900

980

0 500 1000 1500 2000

Developing countries

CEE/CIS

East Asia/Pacific

Latin America/Caribbean

Middle East/North Africa

South Asia

West/Central Africa

East/Southern Africa

maternal mortality ratio (adjusted)

Maternal Mortality (ROSA)

Maternal Mortality

560

92

110

380

420

500

540

740

1900

0 500 1000 1500 2000

South Asia

Sri Lanka

Maldives

Bangladesh

Bhutan

Pakistan

India

Nepal

Afghanistan

maternal mortality ratio (adjusted)

Maternal Mortality (TACRO)

190

27313343608283879596110110130130140150150160160170170

230240260

410420

680

0 200 400 600 800 1000

Latin America/Caribbean

UruguayChileCuba

Costa RicaBahamas

ArgentinaMexico

JamaicaBarbados

VenezuelaHondurasSurinameColombia

EcuadorBelize

DREl Salvador

PanamaTrinidad/Tobago

GuyanaParaguayNicaragua

GuatemalaBrazilPeru

BoliviaHaiti

maternal mortality ratio (adjusted)

Maternal Mortality (MENA)

220

5

23

28

41

54

76

84

87

97

100

120

140

140

150

160

220

250

570

590

730

0 200 400 600 800 1000

Middle East/North Africa

Kuwait

Saudi Arabia

Bahrain

Jordan

UAE

Iran

Egypt

Oman

Libya

OPT

Tunisia

Algeria

Qatar

Lebanon

Syria

Morocco

Iraq

Yemen

Sudan

Djibouti

maternal mortality ratio (adjusted)

Maternal Mortality (CEE/CIS)

64

811

2324

31313232353536

495555

6770

94100

110210

0 50 100 150 200 250

CEE/CIS

CroatiaSerbia/Montenegro

Macedonia, TFYRUzbekistan

Bosnia/HerzegovinaTurkmenistan

BulgariaGeorgiaBelarus

Ukraine Moldova, Rep

RomaniaAlbania

ArmeniaRussian Federation

TurkeyAzerbaijanTajikistan

KyrgyzstanKazakhstan

maternal mortality ratio (adjusted)

Maternal Mortality (EAPRO)

110

2030374144566775

110130130130130

200230

300360

450650660

0 200 400 600 800 1000

East Asia/Pacific

Korea, Rep of

Singapore

Brunei Darussalam

Malaysia

Thailand

China

Korea, Dem Rep

Fiji

Mongolia

Samoa

Solomon Islands

Vanuatu

Viet Nam

Philippines

Indonesia

PNG

Myanmar

Cambodia

Lao PDR

Timor-Leste

maternal mortality ratio (adjusted)

Maternal Mortality (ESARO)

980

24100

230300

370480

550550

630750

850880

100010001000

11001100

14001500

17001800

0 500 1000 1500 2000

East/Southern Africa

Mauritius

Botswana

South Africa

Namibia

Swaziland

Comoros

Lesotho

Madagascar

Eritrea

Zambia

Ethiopia

Uganda

Burundi

Kenya

Mozambique

Somalia

Zimbabwe

Rwanda

Tanzania

Angola

Malawi

maternal mortality ratio (adjusted)

Maternal Mortality (WCARO)

900

150420

510540540570

690690730740760800

850880

99010001000

110011001100

12001600

2000

0 500 1000 1500 2000

West/Central Africa

Cape Verde

GabonCongo

Gambia

Ghana

TogoCôte d'Ivoire

Senegal

Cameroon

Guinea

LiberiaNigeria

Benin

Eq. Guinea

Congo, Dem RepBurkina Faso

Mauritania

CAR

ChadGuinea-Bissau

Mali

Niger

Sierra Leone

maternal mortality ratio (adjusted)