National Maternal Death surveillance and Response: Sri Lankan scenario

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Anita KM Zaidi MMBS, SM Karachi, Pakistan Loss of a woman in the reproductive age has a lasting impact on the family and the society, with a multitude of socioeconomic implications, which often cause deleterious effects at different levels, even many years later. Given the relevance of maternal deaths, many countries across the world have implemented National Maternal Death Surveillance and Response mechanisms [1]. Around each maternal death there are 10-20 women who develop severe acute maternal morbidity, where very ill pregnant or recently delivered women, who would have died had it not been that luck and good care was on their side, survive with immediate and/or long term adverse sequelae [2, 3]. The world loses 830 women every day due to complications of pregnancy and child birth. During the past two decades, the global maternal mortality ratio (MMR) declined by 44%, from 385 to 216 deaths per 100,000 live births. Yet this was below the target set by the millennium developmental goals (MDG 5) which envisaged a reduction of 75% in the MMR by the year 2015 from that of 1990 [4]. The process to reduce global maternal mortality is continuing, and the initiatives are led by the United Nations Maternal Mortality Inter Agency Group which formulated the sustainable development goals (SDG) to be implemented from 2016 and 2030, which target a global maternal mortality ratio of less than 70 per 100 000 live births by 2030, with no country having a MMR of 140 maternal deaths per 100,000 live births [5, 6]. Sri Lanka introduced a Maternal Death Surveillance and Response system (MDSR) in 1981. In 1985, the gazette regulation on mandatory notification of probable maternal deaths was issued, and a structured review of maternal deaths was initiated by Family Health Bureau (FHB) in 1995 with inputs from professional colleges. In 2000, a national maternal death database was established [7]. Every year, of the 360,000 pregnant women who are registered, over 99% receive antenatal care and 99.5% are attended by a skilled birth attendant during confinement. Sri Lanka reported a MMR of 1694 per 100,000 live births in 1947 which gradually declined to reach one of the lowest in the South Asian Region by the turn of the millennium. However, the MMR in the country remains static from 2010 to 2017 fluctuating between 31-39 deaths/ 100,000 live births [8]. Sustainable Developmental Goals (SDGs) for Sri Lanka are to reduce the MMR to 25 per 100,000 live births by 2020, 15 per 100 000 live births by 2025 and to less than 10 per 100 000 live births by 2030 [9]. This would mean the Ceylon Medical Journal 2019; 64: 1-3 National Maternal Death Surveillance and Response: Sri Lankan scenario