October October 20102010 ESA/STAT/AC.219/19ESA/STAT/AC.219/19

Maternal mortality Maternal mortality

3rd Global Forum on Gender Statistics 3rd Global Forum on Gender Statistics Manila, PhilippinesManila, Philippines

Marcela Eternod ArámburuMarcela Eternod Arámburu

Maternal mortality

The maternal mortality ratio reflects the magnitude of a health problem since most of maternal deaths are preventable.

Reducing maternal mortality is one of the main objectives of Mexico’s National Program of Health 2006-2012 and is an international commitment to meet the Millennium Development Goals.

Maternal mortality

The prevention of deaths from these causes depends on the coverage and quality of health services, detection and adequate treatment of complications as well as the timely pipeline of women to a hospital with trained staff trained and the resources needed to execute obstetric emergencies.

SSA officials say that maternal mortality in Mexico currently does not reflect a problem of access to health services, but poor quality of services, with more than 82% of maternal deaths occurring in the hospital (2009).

Maternal mortality

It is widely known that maternal mortality measurement is facing a set of technical problems affecting the indicators.

The data quality is questionable:

• Not all maternal deaths are indentified.

• There are problems of birth registration.

Maternal mortality

In this situation, in Mexico took place in 2002 and 2003 a pilot study that revealed the misclassification of maternal deaths which showed the errors in coding causes of death having consequences on underreporting maternal mortality.

Based on this study, we designed a set of measures, mandatory for all health sector, which aims to find all misclassified maternal deaths in the country and correct them.

Maternal mortality

These actions not only substantially improved the quality of data and consequently of the indicators, but also have given credibility to the maternal mortality data gathered in our country.

Deliberate search of maternal deaths

• Maternal deaths were confirmed.

• Suspected cases of maternal death masked.

• Maternal deaths are not registered.

Maternal mortality

The deliberate search and reclassification of suspected maternal deaths supports the RAMOS methodology "modified" (Reproductive Age Mortality Survey).1

1 Dirección General de Información en Salud.

Sources of information

• Death certificate.

• Confidential questionnaire of maternal death.

• Complete clinical record.

• Verbal autopsies.

• Committee reports of maternal death.

• Group Immediate Care of Maternal Deaths (Aideman).

• Unique Information System for Epidemiological Monitoring (SUIVE).

Sources of information

• Health Information System (SIS).

• Automated System for Hospital Discharge (SAEH).

• The Epidemiological and Statistical Mortality System (SEED).

• Database reporting notification system immediately.

• Reports of the method "Ramos.”

Maternal mortality

Year of registration

Observed maternal deaths

Corrected maternal deaths*

Percentage increase

1990 1 477 2 156 0.461991 1 414 2 108 0.491992 1 399 2 090 0.491993 1 268 2 058 0.621994 1 409 2 021 0.431995 1 454 1 967 0.351996 1 291 1 937 0.501997 1 266 1 874 0.481998 1 417 1 874 0.321999 1 399 1 904 0.362000 1 310 1 697 0.302001 1 253 1 616 0.29

Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2010.* Estimación por subregistro hasta el año 2001 (DGIS/ SSA).

Modified “RAMOS” methodology

Year of registratio

n

Total maternal deaths*

Epidemiological and

statistical system

Deliberate search of maternal deaths

%

2002 1 330 1 155 175 13.2

2003 1 339 1 122 217 16.2

2004 1 273 1 131 144 11.3

2005 1 278 1 124 154 12.1

2006 1 202 1 018 184 15.3

2007 1 157 969 188 16.2

2008 1 167 1 082 85 7.3

2009** 1 281 1 143 138 10.8

2002-200910 027 8 744 1 285

12.8

Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2008..* Incluye muertes tardías, por secuelas y extemporáneas.** Preliminar.

Maternal deaths with deliberate search

Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2008..

Year of registratio

n

Total maternal deaths

Deliberate search of maternal deaths

Late deaths by sequels and

extemporaneous

Maternal mortality

ratio

2002 1 330 1 309 21 59.92003 1 339 1 313 26 62.62004 1 273 1 239 34 60.92005 1 278 1 242 36 61.82006 1 202 1 166 36 58.62007 1 157 1 097 60 55.62008 1 167 1 119 48 57.22009 1 281 1 281   nd 62.2•

Maternal mortality ratio (MMR)

Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2008..

Maternal mortality

857 828

804

228

27

211

32

233217

TMD 1 157

TMD 1 167

TMD 1 281

Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2008..

Direct obstetric causes Indirect obstetric causes Influenza and pneumonia

Quality data

In Mexico…

• it has been made great efforts to improve the recording of maternal mortality.

• has been implemented a complete protocol to review all maternal deaths, confirmed and suspected.

• already is working a procedure to identify late maternal deaths by sequels.

• there is a procedure to reclassify maternal deaths out of time and correct the annual data.

Why it does not consider WHO?

In 2005, Mexico ranked as a country with good estimates of maternal mortality (group A).

But in 2010, WHO made a correction to the data from Mexico without considering all the work has been done to ensure data quality of maternal deaths at the local, state and national levels.

Maternal mortality ratio in Mexico

0

50

100

150

200

250

55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09

histórico corrección OMS Correction by sub

registration

WHO estimates

2010

Deliberate search of maternal deaths

Fuente: Aurora del Río “Estadísticas sobre Mortalidad Materna en México”.

National Center for Gender Equity and Reproductive Health

Action Program 2007-2012:

• Sexual and reproductive health for teens.

• Family planning and contraception.

• Breast cancer.

• Prevention and care of family violence and gender violence.

• Cervical cancer.

• An equal start in life.

• Gender equality in health.

Work programs of specialized technical committees (SNIEG)

• Specialized Technical Committee on Health Sector.

• Specialized Technical Committee on the Information System of the Millennium Development Goals.

• Specialized Technical Committee on Gender-Sensitive Information.

Bibliography

• Aurora del Río “Estadísticas sobre Mortalidad Materna en México”.

• Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA, 2010.

• Prioridades del Centro Nacional de Equidad de Género y Salud Reproductiva.

Thank you