Access to care and maternal mortality in Jamaican hospitals: 1993-1995

Background As part of the reproductive health quality assurance programme, the Ministry of Health sought to review maternal deaths in public hospitals . These hospitals attend 95% of institutional births and 82% of all births. Methods Deaths among females 10-50 years in public hospitals during 1993-19 95 were reviewed to identify pregnancy-related deaths. Cause of death and a ccess to care were compared with previous studies (1981-1983 and 1986-1987 [12 months]). Results The maternal mortality ratio of 106.2 per 100 000 live births, was no different than the 119.7 observed in 1986-1987 and 118.6 for 1981-1983. The leading causes of death remained pre-eclampsia/eclampsia and haemorrhag e. The only significant cause-specific decline occurred among deaths due to ruptured ectopic pregnancy (P=0.012). While in 1986-1987 access to care wa s associated with risk of death from gestational hypertension (P=0.02), the se differences are no longer significant. Differences persist, however, for haemorrhage and all other causes, which were less likely to occur at the m ore skilled institutions. The region with the least obstetricians had the h ighest mortality ratio but the one with the most did not have the lowest ra tio, indicating that quality is more important than quantity. Conclusions Regional differences indicate the capacity to reduce maternal m ortality by at least 50% with re-allocation of skilled personnel and improv ed quality. All hospitals must be able to manage haemorrhage cases as patie nts are unlikely to survive referral.