UNFPAState of World Population 2004
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State of World Population
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Maternal Health

New Approaches
Causes and Consequences
Maternal Morbidity
Obstetric Fistula
Reducing Maternal Mortality and Morbidity
Difficulties in Measurement
Holistic Responses
Antenatal Care
Skilled Attendance
Emergency Obstetric Care
Post-abortion Care
Quality of Maternal Health
Men and Maternal Health
UNFPA and Safe Motherhood

Difficulties in Measurement

Maternal mortality is difficult to measure for both conceptual and practical reasons, making all estimates subject to some degree of uncertainty. In many settings, record keeping is poor, and women’s deaths and their causes may go unreported by families and communities.(24)

In general, the methods used to estimate maternal deaths (using vital registration systems, household surveys, census data and reproductive age mortality studies)(25) provide neither the input needed to design and monitor prevention programmes nor the information needed to assess the availability, quantity and quality of life-saving health services.

Measuring maternal morbidity is also a challenge for many reasons: facility-based data (hospital case reviews and discharge surveys, for example) have inherent biases;(26) clinical monitoring of large populations of pregnant and post-partum women is impractical; self-reports do not provide reliable information; and stigma and fear often make women reluctant to discuss maternal health and complications.

Despite the difficulties, a number of countries have, since the ICPD, put in place measures to improve data collection and record keeping to monitor maternal death and illness. These include Angola, Argentina, Bolivia, Cambodia, Cuba, Morocco, Mozambique, Namibia, Nicaragua, the Philippines, Senegal, Sri Lanka and Zimbabwe. Saint Vincent and the Grenadines holds an annual perinatal morbidity and mortality conference to analyse national data.(27)


The Millennium Development Goal 5, improve maternal health, has a target of reducing the maternal mortality ratio by three quarters between 1990 and 2015. Besides the maternal mortality ratio—which does not address maternal morbidity—the indicator chosen to measure progress is the proportion of births attended by skilled health personnel; this does not address the possibility of a woman having a life-threatening complication requiring emergency care.

To measure these aspects, the Millennium Project Task Force on Maternal Health and Child Health has recommended as an additional target the goal of the ICPD: universal access to reproductive health services by 2015 through primary health care systems. The Task Force further suggests that additional UN process indicators be used, including the number of functioning comprehensive and basic emergency obstetric care facilities per 500,000 population and the proportion of births taking place in emergency facilities (at appropriate levels of care). They also urge attention to ensuring equitable access to these facilities. See Sources

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