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Maternal Health
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)
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MEASURING PROGRESS IN PROVIDING CARE |
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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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