Author — Lillian Topp
Maternal mortality is exactly what it sounds like: the death of a mother. In medical parameters, maternal mortality is defined as the pregnancy-related death of a mother either during their pregnancy or within 42 days of the pregnancy’s termination. Despite the risks associated with pregnancy and childbirth, an estimated 140 million babies are born each year. But how do we know how many babies are born, or how many mothers survive? Maternal mortality data collection, like any other data collection, is far from perfect. The classification of maternal mortality, how it is reported, how maternal mortality ratios are calculated, and who collects the data all collide to form a picture of a maternal mortality data collection system with a lot of room for improvement.
In the plethora of births and pregnancies across the world at any given moment, maternal mortality is not the norm, but adding up to a recent 211 deaths per 100,000 live births worldwide in 2017, it is certainly not insubstantial. On the other hand, this is a clear improvement, down from 342 per 100,000 live births in 2000. World health and wellness Sustainable Development Goals (SDG) target 3.1, which was proposed by the World Health Organization (WHO)’s strategy paper on ending preventable maternal mortality, aims to reduce the number of maternal deaths per 100,000 live births to 70 by 2030.
Statistics regarding maternal mortality do not have a clear path to the clean page of the UNICEF website. Across the world, various agencies and organizations work to collect numbers of women who died during childbirth, though not always collaboratively. In the United States, for example, the CDC has created a system to calculate pregnancy-related mortality ratios called the Pregnancy Mortality Surveillance System. Within the United States, California has its own maternal data center which collects data solely for that state. The WHO leads the United Nations Maternal Mortality Estimation Interagency Group (MMEIG), which comprises WHO, UNICEF (United Nations Children Fund), UNFPA (United Nations Population Fund), the United Nations Population Division, and the World Bank Group. This group works to generate internationally comparable statistics for maternal mortality so that the issue can be more reliably and uniformly monitored worldwide. Additionally, there are smaller initiatives, which are expensive and often privately funded, that go door to door collecting data. In order for this to work, there must be a large enough sample size to gain reliable statistics, especially because maternal mortality can be easily missed if there is not a large sample size due to its rates of occurrence in the population as a whole, which decreases from maternal mortality ratios when maternal deaths are compared to the overall population rather than just the number of births. On top of this, there is a sister method which is used by the DHS and the MICS (UNICEF Multiple Indicator Cluster Surveys) which asks women about the maternal outcomes of their sisters as well as themselves. Overall, there are numerous different organizations that collect maternal mortality data, but what exactly are they collecting, and are they all collecting the same thing?
The maternal mortality ratio is collected as the number of maternal deaths per 100,000 live births. The data collected differs by organization in when the cutoff for a postpartum death falls into the maternal mortality category. For many organizations, it is within 42 days of the end of pregnancy, though others include deaths occurring up to a year or more after pregnancy termination. This leads to disunity in the definition of maternal mortality, and therefore results in fluctuations in the statistics collected that lead to a less clear picture of the actual severity of the issue of maternal mortality. Additionally, many metrics only collect data for maternal deaths related to live births, which misses entire categories of maternal deaths associated with stillbirth and intentional or unintentional loss of pregnancy before fetal viability. Variation in the definition of maternal mortality when data is collected, and the omission of groups of mothers from this data, leads to an incomplete picture of maternal mortality, even under the most scientific of current situations.
Why do the names and funds of various collection agencies matter? Why does the instability of the definition of maternal mortality make such a big difference? The answer boils down to this—the data is there to be used. Who is using it, and what they are trying to understand from it, has implications that have the potential to change maternal healthcare for millions, if not billions, of women for the better. When data is inconsistent, the picture it projects is not necessarily representative of the actual situation, and in order for leaders to use the data to understand and address the situation, they need to know what is actually going on. This relies on the collection of maternal mortality data becoming more streamlined and consistent over the next few years, especially if we want to reach our 2030 target of 70 maternal deaths per 100,000 live births.
Additionally, who measures the data directly impacts how effective that data is, because the leader of collection must rely on their connections across the globe for access and resources in individual nations in order to collect information there. This is the basis for the 4th and 5th principles of improved measurement systems for women’s and children’s health set forth by a group of global health experts upon the commencement of the Sustainable Development Goals in 2015. These are the principles of leadership and country ownership, which state that there should be more country-level leadership and organization across different sectors, including data gathering and management, which would lead to more tailored data that can be used more effectively country by country to address specific problems that each nation faces in the fight against maternal mortality. Ultimately, data collection in maternal mortality has a long way to go. Fortunately, there are people and organizations already putting forth solutions to make data more effective and usable so that leaders across the world can truly impact the health of mothers everywhere.