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Multiple Indicator Cluster SurveysMICS3Regional Training Workshop
Maternal Mortality
MDG Goal 5: Improve maternal health
Target 7: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.
Goals
Optional ModuleMATERNAL MORTALITY
Indicators
• Maternal mortality ratio
• Skilled attendant at delivery
Optional ModuleMATERNAL MORTALITY
Definition of maternal mortality ratio
Number of maternal deaths per 100,000 live births
Optional ModuleMATERNAL MORTALITY
Sources of data for maternal mortality
• Vital Registration systems• Reproductive Age Mortality Studies (RAMOS)• Household Surveys
- Direct Methods
- Sisterhood methods
- Direct
- Indirect
Optional ModuleMATERNAL MORTALITY
Definition of a maternal death
Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not form accidental or incidental causes.
Optional ModuleMATERNAL MORTALITY
Problems in measuring maternal mortality
Requires info on:
• Pregnancy status
• Timing of death (within 42 days of termination of
pregnancy)
• Cause of death
Each of these elements is difficult to measure!
Optional ModuleMATERNAL MORTALITY
Problems in measuring maternal mortality
Vital registration systems:• Underreporting• Misclassification
• In most developed countries with complete vital registration, misclassification and underreporting causes estimates to be underreported significantly.
Optional ModuleMATERNAL MORTALITY
Problems with measurement
Household Surveys:• Maternal mortality is a relatively rare event • When household surveys are used, huge sample sizes are
required
Example:To estimate an MMR of 300 within a 20% margin of error requires a sample of 50,000 births (may imply much larger number of households)
Optional ModuleMATERNAL MORTALITY
Sisterhood Method (indirect)
Advantages• Reduces sample size requirements• Minimal data requirements (5 questions only)• Simple data processing and analysis
Disadvantages• Results reflect a point in time approximately 12 years before the
survey• Wide confidence intervals – cannot be used to measure trends in
the short term
Optional ModuleMATERNAL MORTALITY
Sisterhood Method (indirect)
• How many sisters (born to the same mother) have you ever had?
• How many of these sisters ever reached age 15?
• How many of these sisters (who are at least 15 years old) are alive now?
• How many of these sisters who reached age 15 or more have died?
• How many of these dead sisters died while they were pregnant, or during childbirth, or during the six weeks after the end of pregnancy?
Optional ModuleMATERNAL MORTALITY
Analysis of Results
• A standard data processing program will be provided for this module.
Optional ModuleMATERNAL MORTALITY
Eligibility for Sisterhood Method (indirect)
• If there is no reliable estimate for maternal mortality
• If an approximate level of maternal mortality is needed for advocacy purposes and to draw attention to the problem
• Remember: Because of large confidence intervals around the estimates, the results are not suitable for assessing trends over time.
Optional ModuleMATERNAL MORTALITY