Maternal deaths: First measure, then cut
23 September 2011
A target of having accurate, real-time data (vital statistics) from the vital registration system in all countries by 2020, with major steps undertaken by 2015, has been proposed by Dr Thomas. Frieden, Director of the United States Centers for Disease Control and Prevention (CDC). This would provide timely information to support accelerated action to reduce maternal deaths.
His remarks were made at a meeting called "Measuring and Understanding Maternal Mortality: Strategies to Achieve Data Completeness and Quality", hosted by CDC on 22-23 September 2011, in which the Health Metrics Network (HMN) and its host agency, the World Health Organization participated.
"What is accurately measured can be managed and improved," said Dr Frieden, adding that measurement is also important for the effective and efficient use of scarce resources. According to the CDC, nearly 360 000 (largely preventable) maternal deaths occur each year worldwide, with 99% of those in the developing countries, particularly those in sub-Saharan Africa and South Asia. The family, societal, economic and health consequences are numerous and can be severe. The number of women who suffer debilitating illnesses and lifelong disabilities as a result of pregnancy and childbirth is 10 to 20 times the number of annual maternal deaths.
Maternal mortality, however, is one of the few major health indicators not measured in many countries, said Dr Frieden. A majority of people in Africa and Asia are born and die without ever having a legal record of their life: more than 40% of the world's newborns are not registered. In the 2000s, only nine African countries had 90% or better vital registration coverage of births and only five African countries attained this level of coverage for deaths, representing little progress during the last half century.
Dr Mark Amexo, Senior Technical Officer at HMN, presented, at this meeting, an overview of the HMN priority strategic initiative Monitoring of Vital Events through use of Information Technology (MOVE-IT), describing its work streams and country start-up projects in Africa and Asia, with a timeline leading up to a high-level declaration expected in January 2012 at the African Symposium on Statistical Development in Cape Town. He said that MOVE-IT supports maternal death surveillance and audits, and provides evidence for maternal health interventions to prevent mortality. For instance in Ghana, HMN and partners are helping establish a community-based monitoring and recording of births and deaths, pregnancy tracking and data management system supported by information technology (IT).
In addition to the necessity of counting maternal deaths, it is critical to understand the medical cause of the death which would allow addressing such causes and preventing future deaths through public health action, emphasized the CDC. HMN is also working to determine causes of deaths via verbal autopsy tools. Technological progress; high-level political and financial commitment to the United Nations Global Strategy for Women's and Children's Health and to achieving results and accountability via the United Nations Commission on Information and Accountability; and the pressure of the Millennium Development Goals deadline of 2015 combine to form a perfect good storm to power progress towards better maternal health now.