Estimates of maternal mortality for 1995

Objective To present estimates of maternal mortality in 188 countries, area s, and territories for 1995 using methodologies that attempt to improve com parability. Methods For countries having data directly relevant to the measurement of m aternal mortality, a variety of adjustment procedures can be applied depend ing on the nature of the data used. Estimates for countries lacking relevan t data may be made using a statistical model fitted to the information from countries that have data judged to be of good quality. Rather than estimat e the Maternal Mortality Ratio (MMRatio) directly, this model estimates the proportion of deaths of women of reproductive age that are due to maternal causes. Estimates of the number of maternal deaths are then obtained by ap plying this proportion to the best available figure of the total number of deaths among women of reproductive age. Findings On the basis of this exercise, we have obtained a global estimate of 515000 maternal deaths in 1995, with a worldwide MMRatio of 397 per 1000 00 live births. The differences, by region, were very great, with over half (273000 maternal deaths) occurring in Africa (MMRatio, >1000 per 100000), compared with a total of only 2000 maternal deaths in Europe (MMRatio: 28 p er 100000). Lower and upper uncertainty bounds were also estimated, on the basis of which the global MMRatio was unlikely to be less than 234 or more than 635 per 100000 live births. These uncertainty bounds and those of nati onal estimates are so wide that comparisons between countries must be made with caution, and no valid conclusions can be drawn about trends over a per iod of time. Conclusion The MMRatio is thus an imperfect indicator of reproductive healt h because it is hard to measure precisely. it is preferable to use process indicators for comparing reproductive health between countries or across ti me periods, and for monitoring and evaluation purposes.