Count

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.

A late maternal death is “the death of a woman from direct or indirect obstetric causes, more than 42 days but less than one year after termination of pregnancy”. Like maternal deaths, late maternal deaths also include both direct and indirect maternal/obstetric deaths. Complications of pregnancy or childbirth can lead to death beyond the six-week (42-day) postpartum period, and the increased availability of modern life-sustaining procedures and technologies enables more women to survive adverse outcomes of pregnancy and delivery, and also delays some deaths beyond 42 days that postpartum period. Specific codes for “late maternal deaths” are included in the ICD-10 (O96 and O97) to capture these delayed maternal deaths, which may not be categorized as maternal deaths in routine CRVS systems despite being caused by pregnancy-related events. Direct obstetric deaths (or direct maternal deaths) are those “resulting from obstetric complications of the pregnant state (pregnancy, labour and puerperium), and from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above”. Deaths due to obstetric haemorrhage or hypertensive disorders in pregnancy, for example, or those due to complications of anaesthesia or caesarean section are classified as direct maternal deaths. Indirect obstetric deaths (or indirect maternal deaths) are those maternal deaths “resulting from previous existing disease or disease that developed during pregnancy and not due to direct obstetric causes but were aggravated by the physiologic effects of pregnancy”. For example, deaths due to aggravation (by pregnancy) of an existing cardiac or renal disease are considered indirect maternal deaths. Maternal deaths and late maternal deaths are combined in the 11th revision of the ICD under the new grouping of “comprehensive maternal deaths”. A death occurring during pregnancy, childbirth and puerperium (also known as a “pregnancy-related death”) is defined as: “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death (obstetric and non-obstetric)” this definition includes unintentional/accidental and incidental causes. This definition allows measurement of deaths that occur during pregnancy, childbirth and puerperium while acknowledging that such measurements do not strictly conform to the standard “maternal death” concept in settings where accurate information about causes of death based on medical certification is unavailable. For instance, in maternal mortality surveys (such as those employing the sisterhood method), relatives of a woman of reproductive age who has died are asked about her pregnancy status at the time of death without eliciting any further information on the cause or circumstances of the death. These surveys usually measure deaths to women during pregnancy, childbirth and puerperium (pregnancy-related deaths) rather than maternal deaths.

Recorded or estimated number of maternal deaths. Measurement requires information on pregnancy status, timing of death (during pregnancy, childbirth, or within 42 days of termination of pregnancy), and cause of death.

Impact

Data on maternal mortality and other relevant variables are obtained through databases maintained by WHO, UNPD, UNICEF, and the World Bank Group. 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. The current methodology employed by the Maternal Mortality Estimation Inter-Agency Group (MMEIG) in this round followed an improved approach that built directly upon methods used to produce the previous rounds of estimates published by the MMEIG since 2008. Estimates for this round were generated using a Bayesian approach, referred to as the Bayesian maternal mortality estimation model, or BMat model. This enhanced methodology uses the same core estimation method as in those previous rounds, but adds refinements to optimize the use of country-specific data sources and excludes late maternal deaths. It therefore provides more accurate estimates, and a more realistic assessment of certainty about those estimates. The new model still incorporates the same covariates which are; the Gross Domestic Product per capita based on purchasing power parity conversion (GDP), the general fertility rate (GFR), and proportion of births attended by a skilled health worker (SAB)). The MMEIG has 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 underreporting and, where necessary, adjustment for incompleteness and misclassification of deaths as well as development of estimates through statistical modelling for countries with no reliable national level data. Predominant type of statistics: predicted

Sum of maternal deaths.

Deaths

Every 3-5 years

Continuous

cresswellj@who.int

Jenny Cresswell

Maternal mortality is difficult to measure. CRVS 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 CRVS systems, such as those in developed countries; suffer from misclassification and incompleteness of maternal deaths.