A comparison of approaches to measuring maternal mortality in Bangladesh, Mozambique, and Bolivia

Kavita Singh,Sian Curtis,Karar Zunaid Ahsan,William Weiss,Qingfeng Li

doi:10.1186/s12963-022-00281-8

Abstract

BackgroundMany low- and middle-income countries cannot measure maternal mortality to monitor progress against global and country-specific targets. While the ultimate goal for these countries is to have complete civil registrations systems, other interim strategies are needed to provide timely estimates of maternal mortality.ObjectiveThe objective is to inform on potential options for measuring maternal mortality.MethodsThis paper uses a case study approach to compare methodologies and estimates of pregnancy-related mortality ratio (PRMR)/maternal mortality ratio (MMR) obtained from four different data sources from similar time periods in Bangladesh, Mozambique, and Bolivia—national population census; post-census mortality survey; household sample survey; and sample vital registration system (SVRS).ResultsFor Bangladesh, PRMR from the 2011 census falls closely in line with the 2010 household survey and SVRS estimates, while SVRS’ MMR estimates are closer to the PRMR estimates obtained from the household survey. Mozambique's PRMR from household survey method is comparable and shows an upward trend between 1994 and 2011, whereas the post-census mortality survey estimated a higher MMR for 2007. Bolivia's DHS and post-census mortality survey also estimated comparable MMR during 1998–2003.ConclusionsOverall all these data sources presented in this paper have provided valuable information on maternal mortality in Bangladesh, Mozambique, and Bolivia. It also outlines recommendations to estimate maternal mortality based on the advantages and disadvantages of several approaches.ContributionRecommendations in this paper can help health administrators and policy planners in prioritizing investment for collecting reliable and contemporaneous estimates of maternal mortality while progressing toward a complete civil registration system.

Highlights

Maternal mortality is difficult to measure in many lowand middle-income countries, where 99% of global maternal deaths occur
Overall all these data sources presented in this paper have provided valuable information on maternal mortality in Bangladesh, Mozambique, and Bolivia
United Nations’ Millennium Development Goal (MDG) 5, a three-quarters reduction in maternal mortality from 1990 to 2015, was the most challenging and least met of the health-related MDGs [32]

Summary

Introduction

Maternal mortality is difficult to measure in many lowand middle-income countries, where 99% of global maternal deaths occur In these settings, maternal deaths are frequently not captured in either a country’s routine health information system (HIS) or the civil registration system. The goal is for countries to have complete civil registrations systems in which all vital events, including births and maternal deaths, would be documented. As lowand middle-income countries work to strengthen their civil registration systems, other interim strategies are needed that would provide timely estimates of maternal mortality. Many low- and middle-income countries cannot measure maternal mortality to monitor progress against global and country-specific targets. While the ultimate goal for these countries is to have complete civil registrations systems, other interim strategies are needed to provide timely estimates of maternal mortality

Results

Discussion

Conclusion