Maternal Mortality Estimates, Methods and Consultation Process

Fatima Marinho MD, MPH, PhDCoordinator, Health Analysis and Information Project, PAHO/HSD/HA

Regional Advisory Committee on Health Statistics MeetingHavana, Cuba, 26-28 March 2012

Introduction• UN Maternal Mortality Estimates Interagency

Group (MMEIG)• Joint effort of WHO, UNICEF, UNFPA and the

World Bank, • Technical Advisory Group• 1990, 1995, 2000, 2005, 2008 maternal

mortality estimates• Upcoming: 2010 Estimates

2010 estimates• PAHO did not take part in estimation process• WHO conducted country consultation:

3-4 weeks to review/respond • Most countries reviewed estimates• PAHO collaborated in consultation process• Critics of consultation procedures received

PAHO

Methodology• Available nationally-representative mortality

data • Countries divided into 3 categories based on

available data:- civil registration data- other types of data- no national data

• Uncertainty of estimates

Civil Registration (CR) Data • Data adjusted for incompleteness and

misclassification• In lieu of country-specific information, an

adjustment factor of 1.5 was applied• Data on maternal deaths and live births were

pooled for 5-year periods (1990, 1995, 2000, 2005, 2008)

Without Complete CR• Multilevel regression based on national level

data surveys, census, other sources• PMDF (proportion maternal among deaths of

females of reproductive age): GDP, GFR, skilled attendant at birth (%)

• Adjusting maternal deaths for misclassification (different correction factors applied)

• Multilevel (or hierarchical) model

Indirect Aids maternal deaths• Direct maternal deaths are counted with the

direct maternal deaths

• Separate treatment of indirect death as aggravated by interaction between HIV and pregnancy

Methodology Critics• Includes late maternal deaths • Constant correction factor over time• Use of UN estimates with under- or

overestimation of live births• Omission of discussion of international and

national comparable concepts• Most recent data not included• Missing transparency of methods, sources

used (improved for 2010 estimates)

Data Review• Preliminary WHO Results• PAHO Basic Indicators: annual data request to

countries (reported), December 2011 Update• IHME: Institute of Health Metrics and Evaluation,

Maternal Mortality Estimates and MDG 5 Attainment by Country 1990-2011; Sept 2011. (estimates)

• http://craes.drupalgardens.com/visualizaciones

Comparing MMEIG estimates and data as reported to PAHO

latest available year

Argentina

Brazil

Chile

Cuba

Jamaica

Mexico

Suriname

Venezuela

El Salvador

Nicaragua

Honduras

Discussion

• What should PAHO’s rol be in the estimation, consultation and dissemination of WHO (or other) estimates

• How to better support countries’ responses to international agency estimates?