1. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 1 Maternal Mortality Ratio Comparison of Philippines and International Data and Metadata Presented by Ms. Mildred B. Addawe Philippine National Statistical Coordination Board UN Workshop on MDG Monitoring 2015 and Beyond 10 July 2012

2. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 2 Outline of Presentation I.Background II.Philippine Methodology on the Interim Estimates of MMR III. Comparison of Philippine and International MMR data and metadata A. Definition B. Methodology C. Sources of Data/Agency D. Data Availability/Frequency of Release E. Limitations IV. Way forward

3. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 3 I. Background Goal 5 of the Millennium Development Goals: Improve maternal health Target 5.A: Reduce by three quarters, between 1990 and 2015 the maternal mortality ratio Indicators for monitoring progress Maternal mortality ratio; and Proportion of births attended by skilled health personnel

4. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 4 I. Background Maternal Mortality Ratio The UN defines maternal mortality ratio (MMR) as the ratio of the number of maternal deaths during a given time period per 100,000 live births during the same time-period. A maternal death refers to a female death from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy.

5. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 5 II. Philippine Interim Estimation Methodology Used in Generating MMR for 1990 and 2000-2010 Philippine MMR was measured through national surveys 1993 National Demographic Survey 1998 National Demographic and Health Survey 2006 Family Planning Survey Interim MMR Methodology Methodology was developed in recognition of the need for updated national-level MMR estimates for assessing the Philippine’s performance in meeting the MDG Goal 5 Developed by the Technical Working Group on Mortality Statistics and approved by the Philippine National Statistical Coordination Board Executive Board in 2010

6. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 6 II. Philippine Interim Estimation Methodology Used in Generating MMR for 1990 and 2000-2010 Interim MMR Methodology Used an indirect estimation procedure for coming up with updated MMR using: Boerma’s method based on general levels of fertility and female mortality according to constructed life tables; and Assumed proportions of maternal deaths to total female deaths (PDMF) based on data from the civil registration system

7. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 7 II. Philippine Interim Estimation Methodology Used in Generating MMR for 1990 and 2000-2010 Interim MMR Methodology For establishing the trend since 1970 and baseline estimates based on 1990 and 2000: The level of completeness of birth registration for the years 1970, 1980, 1990 and 2000 were estimated using the P/F ratio method for true cohorts as prescribed by the UN Manual X. The general fertility rates (GFRs) were then calculated using the corrected births and female population in the reproductive age group (15 to 49 years) for 1970, 1980, 1990 and 2000. The general mortality rate for females aged 15 to 49 years was estimated from the existing female life tables for 1970, 1980, 1990 and 2000.

8. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 8 II. Philippine Interim Estimation Methodology Used in Generating MMR for 1990 and 2000-2010 Interim MMR Methodology For estimating MMR for 2001 to 2010: Female life expectancy and GFRs for 2001 to 2010 was estimated using straight line extrapolation of the female life expectancy and GFR for 1990 and 2000 consistent with the observed trends since 1970. General mortality rate for females aged 15-49 years for 2001 to 2010 was estimated using the 2001 to 2010 female life expectancy to locate the corresponding age- specific female death rates from the 1982 UN model life tables and the 2000-based projected female population

9. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 9 II. Philippine Interim Estimation Methodology Used in Generating MMR for 1990 and 2000-2010 Interim MMR Methodology For estimating MMR for 2001 to 2010: Maternal mortality rates were then calculated based on : o different assumptions on the PMDF based on Boerma’s linear regression results o the unadjusted PMDF from 1970 to 2006 from the vital registration systems o lower and upper 95 percent confidence limits of 128 and 196 MMR according to the 2006 Family Planning Survey

10. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 10 II. Philippine Interim Estimation Methodology Used in Generating MMR for 1990 and 2000-2010 Interim MMR Methodology For estimating MMR for 2001 to 2010: The corresponding maternal mortality ratios were then computed by applying Boerma’s formula for each of the assumed PDMFs: Maternal mortality ratio = Maternal mortality rate General fertility rate

11. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 11 II. Philippine Interim Estimation Methodology Used in Generating MMR for 1990 and 2000-2010 Comparison of survey-based and indirect estimates of Philippine MMR: 1990 - 2011 YearSurvey estimates 1/ Indirect interim estimates 2/ 1990121 - 207 1991 1992 1993209 1994 1995 1996 1997 1998172 1999 2000130 - 222

12. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 12 II. Philippine Interim Estimation Methodology Used in Generating MMR for 1990 and 2000-2010 Comparison of survey-based and indirect estimates of Philippine MMR: 1990 - 2011 YearSurvey estimates 1/ Indirect interim estimates 2/ 2001118 - 203 2002115 - 198 2003112 - 193 2004109 - 188 2005106 - 182 2006162103 - 177 2007101 - 172 200899 - 169 200996 - 164 201095 - 163 2011221 1/ Source from 1993 NDS, 1998 NDHS, 2006 FPS and 2011 FHS 2/ Source from the Interim MMR estimates of the TWG-MS

13. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 13 III. Comparison of Philippine and International Data/Metadata Philippine International 1. Definition of MMR Ratio between the number of women who died (for reasons of pregnancy, childbirth and puerperium) to the number of maternal deaths per 100,000 live births Ratio of the number of maternal deaths during a given time period per 100,000 live births 2. MethodologyIndirect estimation procedure using Boerma’s prescribed method for developing countries Multilevel regression model

14. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 14 III. Comparison of Philippine and International Data/Metadata Philippine International 3. Source of data/agency Technical Working Group on Mortality Statistics Trends in Maternal Mortality: WHO/UNICEF/UNFPA/WB 4. Years available1990, 2000-20101990, 1995, 2000, 2005, 2010 5. LimitationsEstimates are based on interim methodology Need to further review PMDF assumptions and MMR estimates

15. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 15 III. Comparison of Philippine and International Data/Metadata YearPhilippines 1/ International 1990121 - 207170 1991 1992 1993 1994 1995140 1996 1997 1998 1999 2000130 - 222120

16. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 16 YearPhilippines 1/ International 2001118 - 203 2002115 - 198 2003112 - 193 2004109 - 188 2005106 - 182110 2006103 - 177 2007101 - 172 200899 - 169 200996 - 164 201095 - 16399 1/ Indirect interim MMR estimates III. Comparison of Philippine and International Data/Metadata

17. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 17 IV. Way Forward On the Philippine Interim MMR Methodology For further review by the TWG-MS, particularly the PMDF assumptions Additional computational exercises shall be done to firm up the MMR estimates Use the updated results of population censuses and surveys and from the CRS as soon as made available

18. Workshop on MDG 2015 and Beyond 10 July 2012 NATIONAL STATISTICAL COORDINATION BOARD 18 Maraming Salamat po! URL: http://www.nscb.gov.ph e-mail: info@nscb.gov.ph