1. October 2010 ESA/STAT/AC.219/19 Maternal mortality 3rd Global Forum on Gender Statistics Manila, Philippines Marcela Eternod Arámburu

2. Maternal mortality The maternal mortality ratio reflects the magnitude of a health problem since most of maternal deaths are preventable. Reducing maternal mortality is one of the main objectives of Mexicos National Program of Health 2006-2012 and is an international commitment to meet the Millennium Development Goals.

3. Maternal mortality The prevention of deaths from these causes depends on the coverage and quality of health services, detection and adequate treatment of complications as well as the timely pipeline of women to a hospital with trained staff trained and the resources needed to execute obstetric emergencies. SSA officials say that maternal mortality in Mexico currently does not reflect a problem of access to health services, but poor quality of services, with more than 82% of maternal deaths occurring in the hospital (2009).

4. Maternal mortality It is widely known that maternal mortality measurement is facing a set of technical problems affecting the indicators. The data quality is questionable: Not all maternal deaths are indentified. There are problems of birth registration.

5. Maternal mortality In this situation, in Mexico took place in 2002 and 2003 a pilot study that revealed the misclassification of maternal deaths which showed the errors in coding causes of death having consequences on underreporting maternal mortality. Based on this study, we designed a set of measures, mandatory for all health sector, which aims to find all misclassified maternal deaths in the country and correct them.

6. Maternal mortality These actions not only substantially improved the quality of data and consequently of the indicators, but also have given credibility to the maternal mortality data gathered in our country.

7. Deliberate search of maternal deaths Maternal deaths were confirmed. Suspected cases of maternal death masked. Maternal deaths are not registered.

8. Maternal mortality The deliberate search and reclassification of suspected maternal deaths supports the RAMOS methodology "modified" (Reproductive Age Mortality Survey). 1 1 Dirección General de Información en Salud.

9. Sources of information Death certificate. Confidential questionnaire of maternal death. Complete clinical record. Verbal autopsies. Committee reports of maternal death. Group Immediate Care of Maternal Deaths (Aideman). Unique Information System for Epidemiological Monitoring (SUIVE).

10. Sources of information Health Information System (SIS). Automated System for Hospital Discharge (SAEH). The Epidemiological and Statistical Mortality System (SEED). Database reporting notification system immediately. Reports of the method "Ramos.

11. Maternal mortality Year of registration Observed maternal deaths Corrected maternal deaths* Percentage increase 19901 4772 1560.46 19911 4142 1080.49 19921 3992 0900.49 19931 2682 0580.62 19941 4092 0210.43 19951 4541 9670.35 19961 2911 9370.50 19971 2661 8740.48 19981 4171 8740.32 19991 3991 9040.36 20001 3101 6970.30 20011 2531 6160.29 Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2010. * Estimación por subregistro hasta el año 2001 (DGIS/ SSA).

12. Modified RAMOS methodology Year of registration Total maternal deaths* Epidemiological and statistical system Deliberate search of maternal deaths % 2002 1 3301 15517513.2 2003 1 3391 12221716.2 2004 1 2731 13114411.3 2005 1 2781 12415412.1 2006 1 2021 01818415.3 2007 1 15796918816.2 2008 1 1671 082857.3 2009** 1 2811 14313810.8 2002-2009 10 0278 7441 28512.8 Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2008.. * Incluye muertes tardías, por secuelas y extemporáneas. ** Preliminar.

13. Maternal deaths with deliberate search Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2008.. Year of registration Total maternal deaths Deliberate search of maternal deaths Late deaths by sequels and extemporaneous Maternal mortality ratio 20021 3301 3092159.9 20031 3391 3132662.6 20041 2731 2393460.9 20051 2781 2423661.8 20061 2021 1663658.6 20071 1571 0976055.6 20081 1671 1194857.2 20091 281 nd62.2

14. Maternal mortality ratio (MMR) Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2008..

15. Maternal mortality 857828 804 228 27 211 32 233 217 TMD 1 157 TMD 1 167 TMD 1 281 Fuente: SSA. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA. México 2008.. Direct obstetric causes Indirect obstetric causes Influenza and pneumonia

16. Quality data In Mexico… it has been made great efforts to improve the recording of maternal mortality. has been implemented a complete protocol to review all maternal deaths, confirmed and suspected. already is working a procedure to identify late maternal deaths by sequels. there is a procedure to reclassify maternal deaths out of time and correct the annual data.

17. Why it does not consider WHO? In 2005, Mexico ranked as a country with good estimates of maternal mortality (group A). But in 2010, WHO made a correction to the data from Mexico without considering all the work has been done to ensure data quality of maternal deaths at the local, state and national levels.

18. Maternal mortality ratio in Mexico Correction by sub registration WHO estimates 2010 Deliberate search of maternal deaths Fuente: Aurora del Río Estadísticas sobre Mortalidad Materna en México.

19. National Center for Gender Equity and Reproductive Health Action Program 2007-2012: Sexual and reproductive health for teens. Family planning and contraception. Breast cancer. Prevention and care of family violence and gender violence. Cervical cancer. An equal start in life. Gender equality in health.

20. Work programs of specialized technical committees (SNIEG) Specialized Technical Committee on Health Sector. Specialized Technical Committee on the Information System of the Millennium Development Goals. Specialized Technical Committee on Gender-Sensitive Information.

21. Bibliography Aurora del Río Estadísticas sobre Mortalidad Materna en México. Búsqueda intencionada de muertes maternas en México. Informe 2008. SSA, 2010. Prioridades del Centro Nacional de Equidad de Género y Salud Reproductiva.

22. Thank you