Review

Measuring maternal mortality: An overview of opportunities and options for developing countries

WJ Graham^1,2 , S Ahmed³ , C Stanton³ , CL Abou-Zahr⁴ and OMR Campbell⁵

¹Department of Obstetrics and Gynaecology, University of Aberdeen, UK

²Immpact, University of Aberdeen, UK

³Department of Population, Family and Reproductive Health, The Johns Hopkins Bloomberg Shool of Public Health, Baltimore, MD, USA

⁴Health Metrics Network, World Health Organization, Geneva, Switzerland

⁵Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

author email corresponding author email

BMC Medicine 2008, 6:12doi:10.1186/1741-7015-6-12

Published:	26 May 2008

Abstract

Background

There is currently an unprecedented expressed need and demand for estimates of maternal mortality in developing countries. This has been stimulated in part by the creation of a Millennium Development Goal that will be judged partly on the basis of reductions in maternal mortality by 2015.

Methods

Since the launch of the Safe Motherhood Initiative in 1987, new opportunities for data capture have arisen and new methods have been developed, tested and used. This paper provides a pragmatic overview of these methods and the optimal measurement strategies for different developing country contexts.

Results

There are significant recent advances in the measurement of maternal mortality, yet also room for further improvement, particularly in assessing the magnitude and direction of biases and their implications for different data uses. Some of the innovations in measurement provide efficient mechanisms for gathering the requisite primary data at a reasonably low cost. No method, however, has zero costs. Investment is needed in measurement strategies for maternal mortality suited to the needs and resources of a country, and which also strengthen the technical capacity to generate and use credible estimates.

Conclusion

Ownership of information is necessary for it to be acted upon: what you count is what you do. Difficulties with measurement must not be allowed to discourage efforts to reduce maternal mortality. Countries must be encouraged and enabled to count maternal deaths and act.