High maternal mortality in rural south-west Ethiopia: estimate by using the sisterhood method

We interviewed 8,870 adults, 15–49 years age, in 15 randomly selected rural villages of Bonke in Gamo Gofa. By constructing a retrospective cohort of women of reproductive age, we obtained sister units of risk exposure to maternal mortality, and calculated the lifetime risk of maternal mortality. Based on the total fertility for the rural Ethiopian population, the maternal mortality ratio was approximated.We analyzed 8503 of 8870 (96%) respondents (5262 [62%] men and 3241 ([38%] women). The 8503 respondents reported 22,473 sisters (average = 2.6 sisters for each respondent) who survived to reproductive age. Of the 2552 (11.4%) sisters who had died, 819 (32%) occurred during pregnancy and childbirth. This provided a lifetime risk of 10.2% from pregnancy and childbirth with a corresponding maternal mortality ratio of 1667 (95% CI: 1564–1769) per 100,000 live births. The time period for this estimate was in 1998. Separate analysis for male and female respondents provided similar estimates.The impoverished rural area of Gamo Gofa had very high maternal mortality in 1998. This highlights the need for strengthening emergency obstetric care for the Bonke population and similar rural populations in Ethiopia.Maternal mortality is defined as the death of a woman during pregnancy or within 42 days after termination of pregnancy from any cause related to or aggravated by the pregnancy or management of the pregnancy [1]. Maternal mortality is particularly high in developing countries [2], where 98% of the yearly 500,000 maternal deaths occur [3,4]. Of the 20 countries with the highest maternal mortalities in the world, 17 are in Africa. The Millennium Development Goals aim to reduce maternal deaths by 75% by 2015 from the 1990 baseline (MDG-5) [5]. The indicator chosen to measure the progress is the maternal mortality ratio (MMR; number of maternal deaths per 100,000 live births). Unfortunately, the progress in many sub-Saharan African countries has been slow or non-existent [6]