2. why is it important?
● Pregnancy and childbirth remain unsafe
● MM is relatively high
● MM is avoidable and preventable
● The necessary interventions are well known
● A case of MM produces a widower and at least one orphan
3. Key facts about MM
● Every day, nearly 830 women die from preventable causes
related to pregnancy and childbirth.
● 99% of all maternal deaths occur in developing countries.
● Maternal mortality is higher in women living in rural areas and
among poorer communities.
● Young adolescents face a higher risk of complications and death
as a result of pregnancy than other women.
● Skilled care before, during and after childbirth can save the lives
of women and newborn babies.
● Between 1990 and 2015, maternal mortality worldwide dropped
by about 44% [not ¾ as in MDG]
5. Definition
The death of a woman while pregnant or within 42 days of
termination of pregnancy, irrespective of the duration and the
site of the pregnancy, from any cause related to or aggravated
by the pregnancy or its management, but not from accidental or
incidental causes
(International Statistical Classification of Diseases, ICD 10, O95, a
part of CHAPTER XV - Pregnancy, childbirth and the puerperium
(O00-O99))
6. Direct obstetric deaths
Direct obstetric deaths are those resulting from obstetric
complications of the pregnancy state (pregnancy, labour and the
puerperium), from interventions, omissions, incorrect
treatment, or from a chain of events resulting from any of the
above.
7. Indirect obstetric deaths
Indirect obstetric deaths are those resulting from previous
existing disease or disease that developed during pregnancy and
which was not due to direct obstetric causes, but which was
aggravated by physiologic effects of pregnancy.
8. Other
Coincidental maternal deaths
Deaths from unrelated causes which happen to occur in pregnancy
or the puerperium
Late Maternal Deaths
The death of a woman from direct or indirect obstetric causes, more
than 42 days, but less than 1 year after termination of pregnancy
9. Pregnancy related deaths
Nearly similar to the above definitions.
Used mostly outside vital statistics domain, but in censuses,
surveys, verbal autopsy, etc. when pregnancy histories and the like
events of the past are collected.
11. Maternal Mortality Ratio
is the number of maternal deaths in a given time period divided
by the number of live births during the same period:
MMRatio=m.Deaths/l.Births (per 100 000)
It is often used as a measure of the quality of a health care
system, and gender equality
It reflects the risk of dying during a single pregnancy
12. Maternal Mortality Rate
is defined as the number of maternal deaths divided by person-
years lived by women of reproductive age in a population
MMRate=m.Deaths/f(15-49).P
It reflects not only the risk of dying during a single pregnancy,
but also how many times a woman faces this risk (i.e., her
fertility level)
13. rates and ratios
The MMRatio is generally regarded as the preferred measure of
maternal mortality because it describes the frequency of
maternal death relative to its risk pool, as measured
(imperfectly, but not badly) by the number of live births. In
practice, however, the MMRatio is prone to measurement bias
because data for the numerator and denominator are often
collected through different means.
14. proportion of maternal deaths
Also useful
PM=m.Deaths/All.15-49.Deaths
Even if a given data source yields an underestimate of the number
of maternal deaths (as occurs quite frequently due to under-
reporting of events), it is plausible that the reported proportion of
maternal deaths is more reliable (Hill et al., 2007).
16. Lifetime risk of maternal death
refers to the probability that a 15-year-old female will die
eventually from a maternal cause if she experiences throughout
her lifetime the risks of maternal death and the overall levels of
fertility and mortality that are observed for a given population.
The adult lifetime risk of maternal mortality can be derived using
either the maternal mortality ratio (MMRatio), or the maternal
mortality rate (MMRate).
It supposes that we have age-specific data, sometimes we have,
then see here.
19. Civil registration: availability of data
(A) countries with relatively complete civil registration systems
and good attribution of causes of death (%% countries/births
37/15)
(B) countries that lack complete registration systems but for
which other nationally representative data are available for
measuring maternal mortality (49/82), and
(C) countries with no available national-level data on maternal
mortality (14/4)
20. data beyond registration:
sample surveys, censuses, periodic inquiries (often called “reproductive-
age mortality studies” or RAMOS), and various ongoing surveillance
systems (including “sample registration” in India). Censuses and some
surveys have been used to collect data on the number of recent deaths
occurring in a household, along with some information about cause of
death (sometimes a complete verbal autopsy). A more common survey
technique is the (direct) sisterhood method, which gathers detailed
information about all past deaths among sisters of respondents, including
whether they occurred during the maternal risk period (but typically
without additional information about the underlying cause of death). More
information about the different data sources is available in (Wilmoth et al.,
2012).
21. for instance Lao census (1995)
Q Did any deaths occur in the household in the last 12
months?
4I If yes: Was the deceased male or female?
Q How old was the deceased (age in completed years)?
4I For women aged 15–49 years and for deaths other than caused by
an accident:
Q Did she die while pregnant, while giving birth, or within 42
days after giving birth?
23. Bureaucracy,
Millennium Development Goal
5
The Millennium Development
Goals (MDGs) are eight
international development
goals that were officially
established following the
Millennium Summit of the
United Nations in 2000
24. Two major sources of information
● the UN family
● Institute for Health Metrics and Evaluation, University of
Washington, Seattle, WA, USA
● other sources are less influential but more doubtful
25. the UN family
UN Maternal Mortality Estimation Inter-agency Group
(during two weeks : HTTP Error 404. The requested resource is
not found. May be due to MDG program is over, thus the site is
over)
A Bayesian approach to the global estimation of maternal mortality
is a good topic to make a presentation at our conference, esp
for those whose topic is far from RH+FP
27. UN, IHME estimates and national data (2012)
Maternal Mortality Ratio
Orange - IHME
Violet - UN MMEIG
Red - National Data
● Uzbekistan
● Kazakhstan
● Ukraine
● Russia
● Germany
● Belarus
31. Interventions
Women’s access to high-quality health services during pregnancy
and childbirth is crucial to save lives.
Essential health interventions include:
● practising good hygiene to reduce the risk of infection;
● injecting oxytocin immediately after childbirth to reduce the
risk of severe bleeding;
● identifying and addressing potentially fatal conditions like
pregnancy-induced hypertension; and
● ensuring access to sexual and reproductive health services and
family planning for women.
32. Resume
● Very popular in advocacy, but very difficult in observation
● Data are scarce, what is published — model driven estimates
● Incompatibility of indicators in many cases
● Lack of events, esp in a developed country or dealing with
national regions
● Easily preventable
