Demonstrating programme impact on maternal mortality

Abstract

Reducing maternal mortality if one of the primary goals of safe mother hood programmes in developing countries. Maternal mortality is not, however, a feasible outcome indicator with which to judge the success of these programmes. This is due to an unfortunate combination of obstacles to measurement--some general to assessing the mortality impact of health programmes and some peculiar to estimating maternal mortality. There is a need to promote alternative views and measures of programme success, and alternative uses for information on maternal deaths.

PIP: Although one of the major goals of the safe motherhood programs in developing countries is to reduce maternal mortality, maternal mortality is not a feasible outcome measure for judging the success of these programs. This is because of the inherent difficulty in measuring levels of maternal mortality and in demonstrating the impact of health programs on mortality. In over 25 years of experience in attempting to measure the impact of health programs on infant and child mortality, the following points have emerged: it is methodologically difficult to demonstrate mortality reduction resulting from comprehensive or selected interventions and, even though downward trends are discernible, it is virtually impossible to differentiate among the various factors contributing to the improvements. Maternal mortality is even more difficult to measure because it is rare (as compared to infant and child deaths), underreported, cause-specific data are rare, existing information is inadequate, and demographic estimation techniques (indirect estimation based on the sisterhood method) yield retrospective estimates only. Although maternal mortality figures do not provide a suitable program measurement outcome, however, the reduction of maternal mortality should continue to be a goal of the safe motherhood program. In addition, maternal mortality should continue to be studied so that the data can be used as an awareness-creating tool and as a quality of care performance indicator. Safe motherhood programs should encompass maternal disease, disability, discomfort, and dissatisfaction as well as mortality.