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A series of validation studies in 3 countries can guide public health actions to address the problem more effectively
To implement actions to end global maternal mortality, which in 95% of cases affects women in low- and lower-middle-income countries, it is not enough to look at official figures. There are different indicators, called “distal”, that open the perspective, capture different less visible aspects
of the problem and could be the subject of public policies to reduce avoidable deaths.
Through a validation study in three countries (Argentina, Ghana and India), we have led an international project together with Harvard University to verify that there is no gap between the real situation and what these indicators record (see here). That is, they effectively serve to reflect reality.
The indicators that we have analyzed in the three countries with their respective publications (and the questions that each one seeks to answer) are the following:
- Legal status of abortion. Are there laws that guarantee access to voluntary termination of pregnancy? And do health providers apply them? See here y here
- Free health services for women of reproductive age. Are all medical check-ups and pregnancy-related practices free? See here
- Density and distribution of health workers. How many health workers are there per 100.000 inhabitants and how homogeneous is their distribution throughout the country? See here (Ghana and India only)
- Quantity and distribution of obstetric personnel in the population. How many graduates in obstetrics, midwives or professional obstetricians are there in the country? How are they distributed and what are their professional skills? See here
- Authorization to attend obstetric emergencies. Do national regulations allow licensed midwives and other non-medical obstetric personnel to attend to emergencies? See here
- Availability of institutions that provide emergency obstetric care. How many health institutions actually provide essential obstetric services? See here
- Geographic distribution of institutions that provide emergency obstetric care. What is the number of health institutions per district and how accessible/proximate are they for pregnant people requiring emergency assistance? See here
- Reliability of official records of maternal deaths. Does the analysis of deaths coincide with the reports from the provincial ministries?
- Satisfied demand for family planning. How satisfied are women with the provision or access to modern contraceptive information and methods? See here
Each of these studies used an individual methodology and analysis plan. And they help illuminate the limitations and adjustments needed for each downstream indicator, thereby underpinning the roadmap toward public interventions that reduce preventable maternal deaths, a key global priority.
By Dr. Mabel Berrueta, director of the Department of Maternal and Child Health Research.