GTR | 2012
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This report explains and compares the different approaches to measuring maternal mortality, focusing on examples from Latin America and the Caribbean (LAC). Accurate measurement of maternal mortality is difficult due to problems in data measurement. Complex models such as those used by MMEIG and IHME are designed to provide the best possible MMR estimates for a large group of countries. Of necessity, they are based on a number of assumptions made because of limited information. Therefore, the resulting estimates have a large range of uncertainty.

• To understand the causes of differences between estimates, one needs to look at input and intermediate data used in the calculations. Thus, GTR strongly recommends that data are made available on a country-by-country basis. For IHME, this means publicly releasing the country-specific data on which their estimates are based. For PAHO, it means collecting the necessary metadata on the methods and the data sources used by each country in calculating the MMR.

• Latin American and Caribbean Demographic Centre (CELADE) and PAHO could play an important role in sharing knowledge about data sources as well as differences in methods and calculations among countries in the region. A concrete step would be to undertake a case study for two or three countries to explain the sources of differences between MMEIG, IHME, and national statistics. Possible countries could be Guatemala and El Salvador (as RAMOS studies have recently been completed there) and Mexico (because national statistics were closer to MMEIG estimates in the past but are closer to IHME estimates in the present). Taking actions of this sort will promote reconciliation among the figures – which will be critical to measure achievements towards the MDGs in 2015.

• Both MMEIG and IHME have each independently assembled a data set of observations on maternal mortality. It would be very useful to combine these data sources and present them online as a central repository of maternal mortality data.

• MMR should be used with care – especially when the overall counts are low, as will usually be the case among countries with small populations. The plausibility of MMR should be assessed, by comparing it to other indicators such as infant and child mortality, fertility, education, and access to health care.