Multiple Indicator Cluster SurveysMICS3Regional Training Workshop

Maternal Mortality

MDG Goal 5: Improve maternal health

Target 7: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.

Goals

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Indicators

• Maternal mortality ratio

• Skilled attendant at delivery

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Definition of maternal mortality ratio

Number of maternal deaths per 100,000 live births

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Sources of data for maternal mortality

• Vital Registration systems• Reproductive Age Mortality Studies (RAMOS)• Household Surveys

- Direct Methods

- Sisterhood methods

- Direct

- Indirect

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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 form accidental or incidental causes.

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Problems in measuring maternal mortality

Requires info on:

• Pregnancy status

• Timing of death (within 42 days of termination of

pregnancy)

• Cause of death

Each of these elements is difficult to measure!

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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 significantly.

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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)

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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

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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?

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Analysis of Results

• A standard data processing program will be provided for this module.

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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.

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