Maternal

Death
Review

Indicators and Analysis

Dr Kaninika Mitra
UNICEF, West Bengal
The need for indicators
• “A quantitative or qualitative factor or variable
that provides a simple and reliable means to
measure achievement, to reflect changes
connected to an intervention, or to help assess
the performance of a development actor”
(DAC Glossary of Key Terms in Evaluation, May
2002)
Types of MDR Indicators
• Process indicators
• Program indicators
• HMIS
CB-MDR Process Indicators

Proportion of maternal deaths investigated in the

district
• Reported versus expected/estimated
• Investigated versus reported

• How do we calculate?
FBMDR Process Indicators
• Proportion of eligible institutions that conducted FBMDR
• Number of maternal deaths reported
• Proportion of maternal deaths investigated
• Proportion of eligible institutions that conducted FBMDR
meetings
• Proportion of minor gaps resolved
• Proportion of major gaps on which action is initiated (proposals
submitted)
• Proportion of major gaps on which action taken (proposals
approved and process begun)

• How do we calculate?
District Level process indicators:
• Proportion of maternal deaths notified vs. estimated.
• Proportion of maternal deaths investigated vs notified.
• Proportion of maternal deaths reviewed versus investigated
• Proportion of MDR meetings conducted by the DM
• Proportion of maternal deaths (among all deaths of RH age
group)
• How do we calculate?
Program indicators-
district & state level
• Proportion of deaths among adolescents (15-49
yrs)
• Distribution of maternal deaths, by district, block
• Distribution of maternal deaths, by education
status, age at marriage, age of death
• Distribution of maternal deaths, by caste, religion
• How do we calculate?
Program indicators …contd
• Distribution of deaths, in antenatal, intra-natal and post-partum
period
• Proportion of deaths during or after abortion-spontaneous &
induced
• Distribution of deaths, by place of death-home, institution, transit
• Distribution of deaths, by ANC & PNC received
• Distribution of deaths, by delays (first, second and third)
• Distribution of deaths by causes
• How do we calculate?
HMIS Indicators:
HMIS formats\bleeding TN reports. xls,
HMIS formats\district hospital.xls
• Number of deaths, by district
• Number of deaths, by month
• Proportion of deaths, by cause
▫ Bleeding
▫ Severe hypertension/fits
▫ Obstructed labor
▫ Fever related
▫ Others
Some examples of indicators calculated
& graphically represented

Based on data from commjunity based

maternal death investigation
(MAPEDIR) in Purulia
Maternal deaths investigated against
reported
160

137
140

120
120

96 99
100 92
90
83
80 71 69 Repo
68
Inves
60

40
28 26

20

0
2005 2006 2007 2008 2009 2010(till July)
Spatial distribution of maternal deaths
DECREASING NUMBER OF REPORTED MATERNAL DEATHS
BLOCK-WISE PROGRESS

2005 2006 2007

2008 2009

2010 (Jan-Jul)
LITERACY STATUS OF THE DECEASED WOMEN
100%

13.2 12.5 10.3

80%

4.7 7.5 12.1

34.9
60%

31.67
37.4
40%
20%

47.2 48.33
40.2
0%

May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010

Illiterate Upto 8th Standard 9th Standard & above DNK

Strongest association with Female Literacy

 AGE AT MARRIAGE
67.3

52.8 50.0
44.3

34.17

22.4

11.67

2.8 3.33 4.7 5.6

0.83

May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010

11-17 years 18-20 years 21-24 >24 Not Known Data not available
100%

10%
16%
26%
80%
60%

59%
77%
64%
40%
20%

25%
12% 9%
0%

May 2005 – July 2006 July 2006-September 2007 May 2008 - March 2010

AGE AT DEATH < 20 20-30 > 30

 TIMING OF DEATHS

8%
21%

71%

ante-natal post-natal

abortion related
 PLACES OF DEATHS

2%
19%

14%
65%
Instituion
Home
Transit
Others
 PROBABLE CAUSES OF DEATH

100%
80%

Others
Injury/accident
Tuberculosis
60%

Malaria
anaemia
40%

Sepsis
Obstructed Labour / Ruptured uterus
Eclampsia/ pre-eclamsia
20%

Haemorrhage
0%

May 2005 – July 2006- May 2008 -

July 2006 Sept 2007 March 2010
There is a
woman behind
every number….!