1. Maternal Mortality Estimates,
Methods and Consultation Process
Fatima Marinho MD, MPH, PhD
Coordinator, Health Analysis and Information Project,
PAHO/HSD/HA
Regional Advisory Committee on Health Statistics Meeting
Havana, Cuba, 26-28 March 2012

2. Introduction
• UN Maternal Mortality Estimates Interagency
Group (MMEIG)
• Joint effort of WHO, UNICEF, UNFPA and the
World Bank,
• Technical Advisory Group
• 1990, 1995, 2000, 2005, 2008 maternal
mortality estimates
• Upcoming: 2010 Estimates

3. 2010 estimates
• PAHO did not take part in estimation process
• WHO conducted country consultation:
3-4 weeks to review/respond
• Most countries reviewed estimates
• PAHO collaborated in consultation process
• Critics of consultation procedures received
PAHO

4. Methodology
• Available nationally-representative mortality
data
• Countries divided into 3 categories based on
available data:
- civil registration data
- other types of data
- no national data
• Uncertainty of estimates

5. Civil Registration (CR) Data
• Data adjusted for incompleteness and
misclassification
• In lieu of country-specific information, an
adjustment factor of 1.5 was applied
• Data on maternal deaths and live births were
pooled for 5-year periods (1990, 1995, 2000,
2005, 2008)

6. Without Complete CR
• Multilevel regression based on national level
data surveys, census, other sources
• PMDF (proportion maternal among deaths of
females of reproductive age): GDP, GFR, skilled
attendant at birth (%)
• Adjusting maternal deaths for misclassification
(different correction factors applied)
• Multilevel (or hierarchical) model

7. Indirect Aids maternal deaths
• Direct maternal deaths are counted with the
direct maternal deaths
• Separate treatment of indirect death as
aggravated by interaction between HIV and
pregnancy

8. Methodology Critics
• Includes late maternal deaths
• Constant correction factor over time
• Use of UN estimates with under- or
overestimation of live births
• Omission of discussion of international and
national comparable concepts
• Most recent data not included
• Missing transparency of methods, sources
used (improved for 2010 estimates)

9. Data Review
• Preliminary WHO Results
• PAHO Basic Indicators: annual data request to
countries (reported), December 2011 Update
• IHME: Institute of Health Metrics and Evaluation,
Maternal Mortality Estimates and MDG 5 Attainment
by Country 1990-2011; Sept 2011. (estimates)
• http://craes.drupalgardens.com/visualizaciones

10. Comparing
MMEIG
estimates and
data as reported
to PAHO
latest available
year

12. Argentina

13. Brazil

14. Chile

15. Cuba

16. Jamaica

17. Mexico

18. Suriname

19. Venezuela

20. El Salvador

21. Nicaragua

22. Honduras

23. Discussion
• What should PAHO’s rol be in the estimation,
consultation and dissemination of WHO (or
other) estimates
• How to better support countries’ responses to
international agency estimates?