Abstract
Tracking progress in the reduction of maternal deaths in developing countries is of great interest at both the national and international levels (e.g. as one of the Millennium Development Goals). To date there have been two approaches to tracking progress: by measuring or estimating maternal mortality ratios (MMRs an “impact” indicator); and by measuring activities designed to avert maternal deaths (“process” indicators) such as proportion of births attended by a skilled person and the availability and use of emergency obstetric care (EmOC). Both of these approaches have their shortcomings. Maternal mortality ratios generally cannot be used to measure change over short periods of time (e.g. 5 years) and wide confidence intervals may make it impossible to say whether a change has actually occurred. Moreover it is difficult to use MMR data to target activities or to link changes in MMR to program activities. As for process indicators while they are helpful in targeting interventions and can show change in a short period of time they do not satisfy the desire to demonstrate progress in terms of reductions in deaths. (excerpt)
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