1. Multiple Indicator Cluster Surveys MICS3 Regional Training Workshop Maternal Mortality

2. MDG Goal 5: Improve maternal health Target 7: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. Goals Optional Module MATERNAL MORTALITY

3. Indicators Maternal mortality ratio Skilled attendant at delivery Optional Module MATERNAL MORTALITY

4. Definition of maternal mortality ratio Number of maternal deaths per 100,000 live births Optional Module MATERNAL MORTALITY

5. Sources of data for maternal mortality Vital Registration systems Reproductive Age Mortality Studies (RAMOS) Household Surveys - Direct Methods - Sisterhood methods - Direct - Indirect Optional Module MATERNAL MORTALITY

6. Definition of a maternal death Death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not form accidental or incidental causes. Optional Module MATERNAL MORTALITY

7. Problems in measuring maternal mortality Requires info on: Pregnancy status Timing of death (within 42 days of termination of pregnancy) Cause of death Each of these elements is difficult to measure! Optional Module MATERNAL MORTALITY

8. Problems in measuring maternal mortality Vital registration systems: Underreporting Misclassification In most developed countries with complete vital registration, misclassification and underreporting causes estimates to be underreported significantly. Optional Module MATERNAL MORTALITY

9. Problems with measurement Household Surveys: Maternal mortality is a relatively rare event When household surveys are used, huge sample sizes are required Example: To estimate an MMR of 300 within a 20% margin of error requires a sample of 50,000 births (may imply much larger number of households) Optional Module MATERNAL MORTALITY

10. Sisterhood Method (indirect) Advantages Reduces sample size requirements Minimal data requirements (5 questions only) Simple data processing and analysis Disadvantages Results reflect a point in time approximately 12 years before the survey Wide confidence intervals – cannot be used to measure trends in the short term Optional Module MATERNAL MORTALITY

11. Sisterhood Method (indirect) How many sisters (born to the same mother) have you ever had? How many of these sisters ever reached age 15? How many of these sisters (who are at least 15 years old) are alive now? How many of these sisters who reached age 15 or more have died? How many of these dead sisters died while they were pregnant, or during childbirth, or during the six weeks after the end of pregnancy? Optional Module MATERNAL MORTALITY

12. Analysis of Results A standard data processing program will be provided for this module. Optional Module MATERNAL MORTALITY

13. Eligibility for Sisterhood Method (indirect) If there is no reliable estimate for maternal mortality If an approximate level of maternal mortality is needed for advocacy purposes and to draw attention to the problem Remember: Because of large confidence intervals around the estimates, the results are not suitable for assessing trends over time. Optional Module MATERNAL MORTALITY