Maternal Death Surveillance and Response serves to have the cause for every maternal death identified, registered and reported in Burkina Faso.
Photo: Jerome Sessini / Magnum Photos
The “black box” of maternal mortality
From television shows we learn how experts go into great depth to find the exact cause of each airplane crash and near-crash. They do so to make flying even safer in the future. It is the same line of thinking that is behind the concept of Maternal Death Surveillance and Response.
Every day about 800 women dies from pregnancy and child-birth related complications. This equals two large jet planes filled with pregnant women crashing every day. But of course these women are not on jet planes. Typically, they are in poor, rural communities in Sub-Saharan Africa or East Asia. And too often their deaths go unnoticed, un-registered, un-investigated by the health systems that should have saved them.
This is where Maternal Death Surveillance and Response comes into the picture. Just as the cause of each plane crash is identified, a Maternal Death Surveillance and Response (MDSR) system serves to have the cause for every maternal death identified, registered and reported. When a country sets up a national MDSR system, the statistics from each front line health post, each health centre and each hospital are communicated in real-time – for instance on a weekly basis - and entered into the central data system.
Such routine registration of maternal death information allows the national health system to identify not only the main causes of maternal deaths, but also geographical variations in mortality burden and causes. And this information allows the health authorities to respond very precisely to the actual causes of maternal mortality in different geographical areas – even down to each service delivery facility.
Promising work through UNFPA
Through Sida, Sweden is a key supporter of the UNFPA Maternal Health Thematic Fund (MHTF). The Fund is working at the global level to promote work towards the elimination of preventable maternal deaths. Maternal Death Surveillance and Response is a key strategy to this end. And while hard data on MDSR results are yet to come, early country examples supported by UNFPA are promising:
Burkina Faso put a system of maternal death surveillance in place. This was linked to a response system that involved in-service emergency obstetric and new-born care training in facilities with high case fatality rates, special procurement of life-saving medicines and equipment for health facilities that lacked appropriate surgical equipment and improved logistical systems to alleviate stock-outs. Early results were very encouraging with registered improvements in maternal deaths already within the first year of activities.
In Burundi, maternal death reviews have been institutionalized since 2011. Burundi with the support from UNFPA has begun to train health providers in charge of community health on how to do autopsies in connection with maternal and new-born case of mortality. This has improved the culture of the mandatory notification of deaths occurring at community level. Thus preventable causes of mortality are increasingly being identified and appropriate response put in place.
The message important step towards change
It is a challenge to ensure data completeness, timeliness and quality in data transmission – an aspect which needs be considered and continuously improved in each country setting.
Benin addressed such issues by creating a centre of excellence in maternal death reviews in the capital. At this centre, trainers from the different health zones in the country had their qualifications upgraded. Also health zones were visited to identify bottlenecks for implementing maternal death reviews and corrective measures were proposed based on the findings.
The adoption of Maternal Death Surveillance and Response frameworks has been supported in 18 countries by the UNFPA Maternal Health Thematic Fund and an additional 11 countries are expected to adopt the framework in 2014.
MDSR holds the promise of serving as an efficient intervention to save women’s lives. Data on the causes of women’s deaths is the black box of maternal mortality. Only with that box in their hands can countries respond effectively to eliminate preventable maternal deaths.
In addition, the implementation of MDSR systems sends a strong message within health systems and to communities: It is not OK for women to die. It is not OK for families to lose their mother. Maternal deaths are not a fact of life that we have to accept. Such messages are in themselves an important step towards change.