Complications during pregnancy and childbirth are a leading cause of death and disability among women of reproductive age in developing countries. The maternal mortality ratio represents the risk associated with each pregnancy, i.e. the obstetric risk. It is also a Millennium Development Goal Indicator for monitoring Goal 5, improving maternal health.
The indicator monitors deaths related to pregnancy and childbirth. It reflects the capacity of the health systems to provide effective health care in preventing and addressing the complications occurring during pregnancy and childbirth.
Definition:
The maternal mortality ratio (MMR) is the annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births, for a specified year.
Disaggregation:
Age, Education level, Location (urban/rural), Wealth : Wealth quintile, Boundaries : Administrative regions, Boundaries : Health regions
Method of estimation:
WHO, UNICEF, UNFPA and The World Bank have developed a method to adjust existing data in order to take into account these data quality issues and ensure the comparability of different data sources.
This method involves assessment of data for completeness and, where necessary, adjustment for underreporting and misclassification of deaths as well as development of estimates through statistical modeling for countries with no reliable national level data.
Data on maternal mortality and other relevant variables are obtained through databases maintained by WHO, UNPD, UNICEF, and WB. Data available from countries varies in terms of the source and methods. Given the variability of the sources of data, different methods are used for each data source in order to arrive at country estimates that are comparable and permit regional and global aggregation.
Currently, only about one third of all countries/territories have reliable data available, and do not need additional estimations. For about half of the countries included in the estimation process, country-reported estimates of maternal mortality are adjusted for the purposes of comparability of the methodologies.
For the remainder of countries/ territories—those with no appropriate maternal mortality data --a statistical model is employed to predict maternal mortality levels. However, the calculated point estimates with this methodology might not represent the true levels of maternal mortality. It is advised to consider the estimates together with the reported uncertainty margins where the true levels are regarded to lie.
Predominant type of statistics: predicted
The maternal mortality ratio can be calculated directly from data collected through vital registration systems, household surveys or other sources. However, there are often data quality problems, particularly related to the underreporting and misclassification of maternal deaths. Therefore, data are often adjusted in order to take into account these data quality issues. Because maternal mortality is a relatively rare event, large sample sizes are needed if household surveys are used. This is very costly and may still result in estimates with large confidence intervals, limiting the usefulness for cross-country or overtime comparisons.
To reduce sample size requirements, the sisterhood method used in the DHS surveys measures maternal mortality by asking respondents about the survival of sisters. It should be noted that the sisterhood method results in pregnancy-related mortality: regardless of cause of death, all deaths occurring during pregnancy, birth, or the six weeks following the termination of the pregnancy are included in the numerator of the maternal mortality ratio.
Maternal mortality is difficult to measure. Vital registration and health information systems in most developing countries are weak, and thus, cannot provide an accurate assessment of maternal mortality.
Even estimates derived from complete vital registration systems, such as those in developed countries; suffer from misclassification and underreporting of maternal deaths.
Due to the very large confidence limits of maternal mortality estimates, the MDG statistics track trends only at the regional level. The country estimates are not suitable for assessing trends over time or for making comparisons between countries.
As a result, it is recommended that process indicators, such as attendance by skilled health personnel at delivery and use of health facilities for delivery, be used to assess progress towards the reduction in maternal mortality.
Method of estimation of global and regional aggregates:
Regional and global aggregates are based on weighted averages using the total number of live births as the weight. Aggregates are presented only if available data cover at least 50% of total live births in the regional or global grouping.
Other possible data sources:
Household surveys
Population census
Sample or sentinel registration systems
Special studies
Preferred data sources:
Civil registration with complete coverage and medical certification of cause of death
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