Academic journal article Bulletin of the World Health Organization

Estimating Pregnancy-Related Mortality from Census Data: Experience in Latin America/Estimation De la Mortalite Liee la Grossesse D'apres Des Donnees De Recensement: Experience Concernant l'Amerique latine/Estimacion De la Mortalidad Relacionada Con El Embarazo a Partir De Datos del Censo: Experiencia En America Latina

Academic journal article Bulletin of the World Health Organization

Estimating Pregnancy-Related Mortality from Census Data: Experience in Latin America/Estimation De la Mortalite Liee la Grossesse D'apres Des Donnees De Recensement: Experience Concernant l'Amerique latine/Estimacion De la Mortalidad Relacionada Con El Embarazo a Partir De Datos del Censo: Experiencia En America Latina

Article excerpt

Introduction

High maternal mortality in developing countries is considered a major public health problem. The issue is of high priority on the international community's public health agenda, as shown by the fact that reducing maternal mortality is the target of UN Millennium Development Goal 5. (1) The difficulties in measuring maternal mortality have been amply documented elsewhere, (2-4) and there is no consensus as to what method is best. The following factors should be considered in choosing a method: the completeness and quality of civil registration; the content and sample size of upcoming national population health surveys; the proportion of births taking place in health facilities; and the completeness and quality of routine health information systems. Recently, greater interest has been shown in using data from the population census to measure maternal mortality, and such use is likely to increase in the future as a result of the endorsement of this method by the United Nations Principles and Recommendations for Population and Housing Censuses. (5)

In attempts to achieve greater accuracy, in the 1980s methods were developed for evaluating and adjusting population census data on household deaths in a defined reference period. (6-9) As a result, in the 1990 census round several countries included questions intended to ascertain if any women of reproductive age had died during pregnancy or within a defined period post-partum, usually 6 weeks. The purpose was to make it possible to estimate pregnancy-related mortality. Data from five of these censuses were analysed in 1999. (10)

The census-based methods that have been developed have several advantages. They yield a greater number of reported pregnancy-related deaths than sample surveys, which makes it possible to analyse differentials. Furthermore, they provide the necessary information for evaluating coverage. But they have disadvantages as well. The number of deaths reported is often biased (generally downwards). Because they are infrequent, censuses cannot be used for routine monitoring. Finally, census-based methods identify pregnancy-related deaths (all deaths occurring during pregnancy and up to 42 days after pregnancy ends), rather than maternal deaths (deaths occurring during pregnancy and up to 42 days after pregnancy ends from any cause related to or aggravated by the pregnancy or its management, but not from incidental causes) (11). Therefore, pregnancy-related deaths overestimate true maternal deaths, though failure to report a death as pregnancy-related (as occurs, for example, with deaths from induced abortion) may in practice bring the numbers closer together. (12,13)

In the 2000 census round, a larger number of countries--Honduras, Nicaragua and Paraguay among them--included questions on the timing of household deaths in relation to pregnancy. This paper analyses the data. from these three countries to draw lessons regarding the feasibility of using pregnancy-related deaths to assess maternal deaths. Throughout the paper we refer to "pregnancy-related deaths" when identified as such in the censuses; we do not call such deaths "maternal" (as is done in the Demographic and Health Surveys (14) and the WHO global estimates of maternal mortality). (15-18) In the discussion section we describe the relationship that probably exists between pregnancy-related deaths and maternal deaths.

This paper supplements the 1999 analysis in two ways: the countries included are in Latin America, a region not previously covered, and alternative data sources provide additional opportunities to evaluate the results.

Methods

To estimate the pregnancy-related mortality ratio (PRMR) from census figures, three types of data are needed: the number of deaths among women of reproductive age, the proportion of those deaths that are pregnancy-related, and the number of births in the period during which the deaths occurred. …

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