Counting every maternal death: Strengthening maternal mortality surveillance and response in the Caribbean

By Aishling Thurow

Aishling Thurow is a Project Support Associate at Management Sciences for Health. 

Every maternal death must be documented to prevent the next one. In the Caribbean, where 175 women die for every 100,000 live births (WHO, 2015), understanding the reasons they died is essential to preventing more unnecessary maternal deaths in the future.

In 2013, the World Health Organization developed guidelines for maternal death surveillance and response (MDSR) to capture the number and systemic causes of maternal deaths and to strengthen policies and programs that will better respond to maternal health needs.

Delegates and organizers from the Technical Consultation on the Maternal Death Surveillance and Response Guidelines (MDSR): Region of the Americas. Dec. 9, 2016. Montego Bay, Jamaica. Photo by Aishling Thurow/MSH

In December 2016, the Latin America and Caribbean Regional Task Force for the Reduction of Maternal Mortality (GTR for its Spanish acronym), of which MSH is an Executive Committee member, hosted a technical consultation on guidelines for maternal death surveillance and response systems in the Caribbean. Held in Montego Bay, Jamaica, the workshop welcomed 20 delegates−Ministry of Health officials, as well as prominent maternal mortality surveillance experts−from Jamaica, Belize, Suriname, Guyana, and Trinidad and Tobago. The workshop aimed to strengthen maternal mortality surveillance and response systems in the sub-region, to improve maternal mortality data quality, and to strengthen policy development and implementation capacities at the national level.

Throughout this conference, the delegates presented and discussed the various MDSR issues within their countries, shared their achievements, and worked in groups to strategize specific and achievable actions to improve their MDSR systems. Some of the main takeaways from this workshop include:

Surveillance systems are critical for gathering accurate data. Underreporting of maternal deaths is extremely common throughout the world, which makes maternal mortality analysis and evaluation particularly difficult. For example, one 2008 study in Jamaica found that under-reporting could result in an MMR of 28.3 per 100,000 live births, when in reality, it would be 117.8 (Janseth Mullings, Jamaica).

Underreporting = incompleteness (non-identification of death, or late registration more than 3 months after death) + misclassifications (incorrect coding of death).

Assigning blame to maternal deaths is counterproductive. When evaluating the reasons for a maternal death, it is important to examine the systemic failure, rather than blaming a specific individual. Blaming individuals fosters under-reporting, and erodes health worker motivation, contributing to poor quality of care. On the other hand, maternal mortality is largely a health systems issue, and applying a system-wide framework to analysis can drive more effective change in the system.

Dissemination of information and evidence is critical for strategic response. While the data generated from surveillance evaluation activities generally goes to policy makers, it often does not reach the general public. But an engaged public is necessary for behavior change and holding governments accountable.

Near-miss maternal deaths are an important part of MDSR. Data on near-miss cases helps to inform obstacles that can be overcome at the onset of complication, identify successful corrective actions, offer the opportunity to gain patient insight, and, as they are more common than deaths, can result in improved statistical significance.

Every country faces its own unique set of challenges and strengths. For example:

  • Belize has a well-functioning electronic vital statistics database, which promotes surveillance and analysis. However, health care staff trained on coding and entering data into maternal mortality surveillance systems are leaving Belize for better opportunities in other countries. This turnover of health care personnel  affects the quality of care available.
  • In Guyana, surveillance mechanisms have led to concrete policy and protocol changes, yet a significant challenge is to improve the accountability of policy makers and implementers.
  • Suriname has a relatively strong surveillance system, with an audit committee that drives analysis and guides policy. However, they are also working to improve the capacity of their health workforce.

Strengthening health systems that more effectively meet maternal health needs requires surveillance and strategic response based on data. This workshop, similar to the 2015 GTR workshop for Latin American countries, provided concrete and actionable strategies that delegates can take back to their countries and help improve their MDSR systems. Based on specific requests from delegates at the Caribbean workshop, the GTR will continue to organize actions to strengthen maternal mortality surveillance and provide technical support in 2017.

For more information, read the MDSR Guidelines for the Americas region.

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