Even though 350,000 women die due to pregnancy related causes each year, maternal deaths are still a relatively rare event. While this doesn’t mean we should not concern ourselves with maternal mortality, it does mean that measuring it and its causes is difficult. In countries without robust vital registration (most of the developing world), even national estimates are difficult to generate and much more difficult to generate are regional estimates. Given what we know about differences between countries’ maternal mortality ratios (MMR), it stands to reason that there are differences within countries.
A paper published last week by BMC Pregnancy and Childbirth develops a subnational maternal mortality rate for a rural district in Mali using the indirect sisterhood method. One of the main advantages of this method, especially in high fertility settings, is that each respondent likely has more than one sister, which significantly increases the sample size. For example, in this study, the researchers interviewed 2,039 people, but were able to report on 4,628 women.
The authors find an MMR for 1999 of approximately 3,131 deaths per 100,000 live births in Kita, Mali, nearly twice as high as the highest country estimate for the year 2000 from the UN MMR estimates from last year:
Our study provides a quick reference point for MMR in a rural poorly developed area with a particularly low literacy rate and poor access to health services. Some villages had particularly high maternal mortality, and these villages also had a higher overall mortality rate. Villages with high mortality rates were all remotely located and this underscores the importance of access to health services for the prevention of maternal deaths.