Measuring maternal mortality: An overview of opportunities and options for developing countries

Since the launch of the Safe Motherhood Initiative in 1987, new opportunities for data capture have arisen and new methods have been developed, tested and used. This paper provides a pragmatic overview of these methods and the optimal measurement strategies for different developing country contexts.There are significant recent advances in the measurement of maternal mortality, yet also room for further improvement, particularly in assessing the magnitude and direction of biases and their implications for different data uses. Some of the innovations in measurement provide efficient mechanisms for gathering the requisite primary data at a reasonably low cost. No method, however, has zero costs. Investment is needed in measurement strategies for maternal mortality suited to the needs and resources of a country, and which also strengthen the technical capacity to generate and use credible estimates.Ownership of information is necessary for it to be acted upon: what you count is what you do. Difficulties with measurement must not be allowed to discourage efforts to reduce maternal mortality. Countries must be encouraged and enabled to count maternal deaths and act.In 2000, 189 countries signed-up to improve maternal health as one of the eight Millennium Development Goals (MDGs). Progress towards this MDG-5 can be measured using a wide variety of indicators [1]. Government and donor commitments to maternal health can be monitored using financial indicators and policy approvals. Investment in maternal health programmes can be tracked by measuring inputs (such as midwifery training), outputs (such as the number of midwives posted) and processes (such as the uptake of skilled delivery care) [2]. These indicators are necessary for planning, implementing and monitoring initiatives to improve maternal health. However, there is also a need to show progress in terms of impact: reduced mortality, complications and disabilities, and improved health. In general, however, it is easie