Assessing maternal mortality in developing countries

According to the World Health Organization, about half a million women die each year due to pregnancy or childbirth [1]. Over half of these women are African (53% in 1995), while the rest are Asian (42%) and to a lesser extent Latin American (4%). Less than 1% of maternal deaths occur in Europe or North America (see table). In order to offset the variations linked to population size or birth rates, one usually refers to the maternal mortality ratio, which is the number of maternal deaths per hundred thousand live births. This measure makes it possible to compare death risks linked to childbirth in different regions or countries of the world (see table and figure). But what do these statistics actually reflect, and how are they generated? Indeed, the notion of maternal death is quite complex; it is difficult to define and as a result, difficult to use (see box 1).