Measuring maternal mortality: sense and sensitivity

The majority of maternal deaths in developing countries are preventable. The long overdue recognition of this tragic fact, together with the mounting evidence of the sheer magnitude of the problem, has strengthened the need to interpret these deaths from the perspective of the family. The conventional measures of maternal mortality disguise the impact of these family tragedies since they inadequately reflect the influence of the level and pattern of fertility and the lifetime risk of childbearing. These inadequacies have important programme implications. Using data from a selection of developing countries, the paper shows that women in their prime reproductive period contribute the greatest number of maternal deaths. These women also have the greatest number of young, dependent children whose own survival and well-being may be seriously compromised by the death of their mother. In many developing countries, maternal health care is often targeted on women outside the prime childbearing period who, whilst having the highest risk of dying once they are pregnant, also have a much lower chance of being pregnant in the first place and will have relatively fewer dependent children. This strategy limits the potential reduction in the number of maternal deaths and overlooks the wider familial repercussions of these tragic events.