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Methods to estimate maternal mortality: a global perspective
  1. Serena Donati,
  2. Alice Maraschini,
  3. Marta Buoncristiano,
  4. the Regional Maternal Mortality Working Group
    1. National Centre for Epidemiology, Surveillance, and Health Promotion—Istituto Superiore di Sanità, Italian National Institute of Health, Rome Italy
    1. Correspondence to Serena Donati, National Centre for Epidemiology, Surveillance, and Health Promotion—Istituto Superiore di Sanità, Via Giano della Bella 34 – 00162 Rome, Italy; serena.donati{at}

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    The maternal mortality ratio (MMR) is globally a reproductive health core indicator, and the death of a woman, while pregnant or within 42 days of termination of pregnancy, is always, anywhere and anyway, a tragedy for the entire community. Reducing the MMR is one of the Millennium Development Goals and the UN Global strategy for women's and children's health mobilised multiple resources and commitments to accelerate this objective.1 However MMR estimates and accurate identification of the causes of maternal death are still a complex and difficult challenge. In most developing country settings, owing to the lack of complete and accurate civil registration systems, MMR estimates are based on data from a variety of alternative sources including censuses, household surveys, reproductive age mortality studies and verbal autopsies.2 The WHO classified 183 countries/territories according to the availability and quality of maternal mortality data: 67 countries (covering 17% of births) having complete civil registration data with good attribution of causes of death, 96 countries (covering 81% of births) having incomplete civil registration and/or other types of maternal mortality data and 20 countries (covering 2% of births) lacking national data on maternal mortality. For the last two categories, a regression model has been developed to estimate maternal mortality figures.3 The Demographic and Health Surveys Program4 uses the sisterhood method for Maternal Mortality estimations. This method remains the major source of empirical data on maternal mortality in developing countries, although it presents notable limitations. All deaths with unknown status about pregnancy are in fact classified as non-maternal and almost half of the surveys have more …

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    • Collaborators The Regional Maternal Mortality Working Group: Simona Asole, Vittorio Basevi, Monica Da Frè, Gabriella Dardanoni, Domenico Di Lallo, Valeria Dubini, Camilla Lupi, Luisa Mondo, Marcello Pezzella, Renato Pizzuti, Arianna Polo, Raffaella Rusciani, Daniela Spettoli, Fabio Voller.

    • Contributors SD wrote the article and is the guarantor. AM and MB performed the literature search. All the authors and working group members read and approved the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.