Enhanced Surveillance of Maternal Mortality in North Carolina

to 12.3 deaths/100,000 live births (See Figure 1). Over the same time span, the annual number of pregnancy-related deaths decreased from 593 to 14. The decline in pregnancyrelated deaths (based on death certificate records) is attributed to improved obstetrical care and particularly the use of effective antibiotics, which dramatically reduced deaths due to infection. 1 The legalization of induced abortion in the early 1970s significantly furthered the decline in pregnancyrelated deaths in North Carolina 1,2 by removing the risk of illegal abortion. 2 Since there has been a very large reduction in pregnancyrelated deaths over this century, one might ask why public health officials are still interested in maternal mortality. First, because maternal mortality is an indicator of the overall effectiveness of the obstetrical health care system and the health care system in general. Second, because persisting, still large discrepancies in maternal mortality among various demographic groups indicate the potential for further prevention. Third, because there has been little improvement in maternal mortality in North Carolina and the United States since the early 1980s. And fourth, because we have not nearly reached the Healthy People 2000 goal of 3.3 maternal deaths/ 100,000 live births. A persisting problem is that pregnancy-related deaths, though relatively rare, are seriously underreported in death certificate data. The State Center for Health Statistics and Wake Forest University School of Medicine are cooperating in a program to enhance surveillance of pregnancy-related deaths in North Carolina. A more complete ascertainment of pregnancy-related deaths and better characterization of the causes should allow us to prevent many of these deaths. The State Center for Health Statistics links several data bases in order to identify pregnancy-related deaths. 3 The