Monitoring and Preventing Maternal Mortality

Maternal Mortality Surveillance

Although conditions have improved in recent years in much of the world, many women in developing countries still die in childbirth or of pregnancy-related causes. Yet, in places that lack strong vital registration systems, a large proportion of these deaths may go unrecorded—and thus officials do not really know the extent of the maternal mortality problem and often don’t have good information on which to base programs to reduce maternal mortality. To bring about improvements to maternity care and to save lives, policy makers need solid evidence of the scope and locations of the problem.

CDC's Division of Reproductive Health (DRH) is working with three countries in Latin America—El Salvador, Paraguay, and Honduras—to improve their maternal mortality surveillance systems. DRH also has been asked to provide assistance in establishing a complete and effective maternal mortality surveillance system by the Government of Ghana. CDC's Division of Reproductive Health is providing the full spectrum of assistance, depending on the country’s need, from planning a new surveillance system to analyzing data from an already functioning system.

In Guatemala, a Reproductive Age Mortality Studies (RAMOS) study was conducted, followed by establishing an on-going surveillance of maternal mortality. In 2008–2009, CDC's Division of Reproductive Health conducted a national RAMOS in Georgia, the first ever in Eastern Europe and the Commonwealth of Independent States. It was also the first national RAMOS study in Europe that employed a full investigation of all deaths to women of reproductive age (15–49 years of age) rather than a sample. The RAMOS studied all deaths to reproductive age women that occurred in 2006, and found both underreporting and misclassification of causes of death in the vital registration system; revealing that only about a third of maternal deaths were officially reported. Results also indicated that maternal deaths in Georgia could be reduced if women were better informed about the risk that pregnancy poses to pre-existing conditions, early signs of pregnancy complications and their prevention, and the importance of immediately seeking emergency obstetric care once complications arise. 

Internet Reporting of Maternal Mortality

An effective maternal mortality surveillance system tells decision makers and officials how many women are dying of pregnancy-related causes, what specifically those causes are, and where these deaths are occurring. This information can not only provide the foundation for planning effective maternal health services, but also can help track the improvements in mortality that these services bring about over time. In Colombia, CDC's DRH is working with the Ministry of Social Protection and with the Pan American Health Organization to speed up and increase the accuracy of the reporting and analysis of maternal mortality data through the use of the innovative Web-based Maternal Mortality Epidemiological Surveillance System. This Web-based system is being piloted in Colombia, and if effective, may be used in other countries.

Prospective Tracking of Maternal and Infant Health Outcomes (Kisumu, Kenya and Ifakara, Tanzania)

Rates of illness and death among mothers and infants are still regrettably high in much of Sub-Saharan Africa. In an effort to assess the use of emergency obstetric care and other services, including the unmet need for such services, CDC's DRH is engaged in prospective pregnancy tracking in Demographic Surveillance Sites in Kenya and in Tanzania. Data were collected through postpartum interviews with the mothers; these interviews complemented the current practices of demographic surveillance programs to track a variety of health indicators. CDC's DRH is analyzing these data to see how and where care and services can be improved and will provide this information to the district- and national-level government health services. Results will be used to develop more effective programs and services to improve health and reduce death rates. The lessons learned in these studies may be more broadly applicable in other areas of Africa.