Current Resources for Evidence-Based Practice, September/October 2016.

Two recent reports focus on maternal mortality. Use of a sophisticated new model yielded updated time series estimates of maternal deaths worldwide and the global maternal mortality ratio (MMR) from 1980 to 2008. The model uses new statistical methods and previously untapped data sources including traditional vital statistics and census data, as well as sibling surveys and verbal autopsy reports, to estimate trends in maternal mortality in 181 countries. The resulting estimates suggest that the number of maternal deaths has decreased significantly over the last few decades, providing affirmation of progress and momentum for redoubled efforts. The report estimated 342,900 maternal deaths in 2008, down from 526,300 in 1980 (an average annual decline of 1.5%). The analysis revealed wide variation in both maternal death rates and trends over time between countries. Of significance were increased rates of maternal mortality in the United States, Canada, and Norway. The authors attributed some of the observed increase to recent changes in data collection techniques: inclusion of late maternal deaths, not traditionally included in international MMR comparisons, within the ICD 10 code; and a new question to determine pregnancy status on the US death certificate. While the former change might result in over-estimation in countries whose estimates are drawn primarily from ICD codes, the latter potentially reveals a more accurate count of US maternal deaths. An unpublished maternal mortality review conducted by the Department of Public Health in the state of California suggests that not all of the observed increase in maternal deaths is attributable to changes in measurement but may also be associated with practice patterns including increased rates of elective induction and cesarean delivery. A second report on maternal mortality released by Amnesty International characterizes the increase in the US national MMR over the last few decades as a human rights crisis. This white paper from the prominent human rights advocacy group calls attention to unequal access, treatment, and risk of death from pregnancy-related causes in the United States, as well as profound health system failures in the areas of insurance coverage, workforce distribution, quality and continuity of care, and system accountability and oversight.