Maternal deaths per 100 000 live births, max of cod and clinical data

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Data set notes

European Health for All database

Indicators: 565

Updated: 18 October 2024

Contact: Data and Digital Health Unit (DDH)

The following abbreviations are used in the indicator titles:

• SDR: age-standardized death rates (see HFA-DB user manual/Technical notes, page 13, for details)

• FTE: full-time equivalent

• PP: physical persons

• PPP$: purchasing power parities expressed in US $, an internationally comparable scale reflecting the relative domestic purchasing powers of currencies.

More information: http://www.euro.who.int/en/data-and-evidence/databases/european-health-for-all-database-hfa-db

Joint Monitoring Framework (JMF)

The joint monitoring framework (JMF) is used for reporting on indicators under three monitoring frameworks: the Sustainable Development Goals (SDGs), Health 2020 and the Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCDs) 2013–2020. The Regional Committee for Europe adopted the JMF in September 2018.

The majority of JMF indicators in the Gateway are linked to existing databases in the Gateway.

Background documents

EUR/RC68/10 Rev.1 Briefing note on the expert group deliberations and recommended common set of indicators for a joint monitoring framework
http://www.euro.who.int/en/about-us/governance/regional-committee-for-europe/past-sessions/68th-session/documentation/working-documents/eurrc6810-

EUR/RC68(1): Joint monitoring framework in the context of the roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being
http://www.euro.who.int/en/about-us/governance/regional-committee-for-europe/past-sessions/68th-session/documentation/resolutions/eurrc68d1

Developing a common set of indicators for the joint monitoring framework for SDGs, Health 2020 and the Global NCD Action Plan (2017)
http://www.euro.who.int/en/health-topics/health-policy/health-2020-the-european-policy-for-health-and-well-being/publications/2018/developing-a-common-set-of-indicators-for-the-joint-monitoring-framework-for-sdgs,-health-2020-and-the-global-ncd-action-plan-2017

Indicator notes

Maternal deaths per 100 000, max of cod and clinical data
Indicator code: E080109.F This indicator shares the definition with the parent indicator \"\".

A maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes (see ICD-10 manual, vol. 2). Normally, maternal mortality cases are reported to WHO as a part of general mortality data by cause, sex and age. However, in some countries due to the national death certification practices, the number of maternal deaths reported in this way is significantly lower (i.e. coded to another ICD code) as compared with maternal deaths registered in health establishments. These cases are usually reported separately to the Ministry of health and are available as a part of national health statistics. These figures, if different from numbers reported with general mortality data, should be entered under this indicator.

Country/Area notes

Armenia

Country specific sources and methods
Source of data: National Health Information Analytic Center, Ministry of Health of the Republic of
Armenia http://moh.am/?section=static_pages/index&id=625&subID=824,29. Data collected annually,
reference period: 31 December.

Austria

Source: Statistics Austria.
Break in time series:
2014: New electronic data collection system was introduced.

Belgium

Source: Statistics Belgium (National Institute for Statistics).

Croatia

Source: Croatian Central Bureau of Statistics - mortality statistics

Czechia

Source: Clinical data. Year 2002: deaths by XV Chapter of ICD-10.

Denmark

Source: Cause of Death Register (DAR), The Danish Health Data Authority.
Method: The number of deaths with cause O00-O99.

Estonia

Annual reporting from health establishments (National Institute for Health Development) compared
with mortality data (Statistical Office of Estonia). In 2012 ? one of the two reported maternal
deaths was caused by other causes not related to pregnancy, childbirth and the puerperium.

Finland

Source: Cause-of-Death Register, Statistics Finland

France

Source of data: Centre d?epidemiologie des causes de deces ( inserm)

Georgia

Source: National Centre for Disease Control and Public Health of Georgia (NCDC) (http://www.ncdc.ge)

Germany

Source: Federal Statistical Office, Statistics on the causes of death, Fachserie 12, Reihe 4.
http://www.destatis.de or http://www.gbe-bund.de
Coverage: Data contains the number of maternal deaths (ICD-10: O00-O99 Pregnancy, childbirth and the
puerperium). Excluded are cases of late maternal deaths coded with ICD-10 O96 (Death from any
obstetric cause occurring more than 42 days but less than one year after delivery) and O97 (Death
from sequelae of obstetric causes).
Break in time series: From the reporting year 1998, for the first time, data have been collected
according to ICD-10. In the years before 1998, data have been collected according to ICD-9 and cases
on late maternal deaths could not be separated.

Hungary

Source: Yearbooks of Demographic and Health Statistics of the Hungarian Central Statistical Office
(KSH).

Iceland

Source: The Icelandic Birth Registration.

Ireland

Source: up to 2010: Central Statistics Office. Figures prior to 2007 refer to ICD-9 630-676. From
2007 figures refer to ICD-10 O00-O99.
Break in Series: From 2011, source used is the Confidential Maternal Death Enquiry in Ireland.
Figures refer to the number of direct and indirect maternal deaths. Direct deaths are defined as
deaths resulting from obstetric complications of the pregnant state (pregnancy, labour and
puerperium), from interventions, omissions, incorrect treatment or from a chain of events resulting
from any of the above. Indirect deaths are defined as those resulting from previous existing
disease, or disease that developed during pregnancy and which was not the result of direct obstetric
causes, but which was aggravated by the physiological effects of pregnancy.
Data for 2011 refer to the average number of deaths which took place 2010-2012 as per the
Confidential Maternal Death Enquiry?s method of producing data over a 3-year rolling average period.
Similarly, data for 2012 refer to the average number of deaths which took place 2011-2013.

Israel

Source: Medical Administration, Ministry of Health.

Italy

Source: ISTAT, Causes of death register.

Lithuania

Source: Health Information Centre of Institute of Hygiene (HI HIC) Causes of death register data.

Luxembourg

Source: Direction de la Sante Service des Statistiques, extracted from the certificate of death,
probably underestimated maternal mortality.

Malta

Source: Department of Health Information and Research (National Mortality Register).

Netherlands

Source of data: Statistics Netherlands, Cause of death statistics. ICD-9: 630-676 / ICD-10:O00-099.

North Macedonia

Source: State Statistical Office (SSO)

Norway

Source of data: Statistics Norway, Statistics on causes of death. Register of causes of death.
Coverage: The statistics on causes of death comprise all deaths, covering Norwegian residents,
whether the person in question was a Norwegian citizen or not and irrespective of whether the deaths
occurred in Norway or not.
Methodology:
- Statistics on causes of death has been published annually by Statistics Norway from 1925.
Statistics Norway's Division for Health Statistics is the data processor for the Cause of Death
Registry, which is owned by the Norwegian Institute of Public Health (FHI).
- ICD-10 was implemented in 1996.
Further information: http://www.ssb.no/dodsarsak_en.

Poland

Source of data for the period 1999-2004: UNDP report ?Health of women in the reproductive age 15-49?

Republic of Moldova

This indicator is calculated by the formula: (total number of maternal deaths * 100000) / total
number of live births.
Source of data: Medical death certificate

Serbia

Source of data: National Statistical Office, Institute of Public Health of Serbia.
Coverage: from 1998 onwards data do not cover Kosovo and Metohija Province that is under the interim
civilian and military administration of the UN.
From 2007 onwards, data are obtained by applying the methodology of triangulation, using death
certificates, birth certificates and hospital discharge reports as sources of data.

Slovakia

Source: Statistical Office of the Slovak Republic

Slovenia

Source of data: National Institute of Public Health, Slovenia (NIJZ)

Spain

Source: Ministry of Health, Social Services and Equality. Statistics on Health Establishments
Providing Inpatient (www.msssi.gob.es)
Coverage: The data reported are the maternal deaths registered in hospitals public and private

Sweden

Source of data: National Board of Health and Welfare (NBHW)
The Causes of Death Register (NBHW)
Online Database: http://www.socialstyrelsen.se/statistics/statisticaldatabase

Non-residents dying in Sweden are not included in the statistics. The causes of death are classified
according to the English language version of the International Statistical Classification of
Diseases and Related Health Problems, Tenth Revision (ICD-10), including the official updates
published on the World Health Organization?s (WHO) website. Since 1987 the ACME system, developed by
the National Center for Health Statistics in the United States, has been used to select the
underlying cause of death. Automated coding of diagnostic terms reported on the death certificate
was introduced in 1993.

Türkiye

Source of data: Public Health Institution of Turkey, Ministry of Health of Turkey.

Turkmenistan

Source of data: Administrative medical statistics, form 19 ?Report on medical care for pregnant
women, women in labour and puerperant?, form 066/y ?Hospital discharge record? and 106/y ?Medical
death certificate?.

Ukraine

Source: State Statistic Department.

United Kingdom

Data are not available.

General notes

Understanding Maternal Mortality: An Overview

Maternal mortality, defined as the death of a woman during pregnancy, childbirth, or within the postpartum period, remains a critical health indicator globally. The rate of maternal deaths per 100,000 live births provides essential insights into the effectiveness of healthcare systems in managing maternal health. This indicator not only reflects the direct medical capabilities but also highlights broader socio-economic factors influencing maternal care. By examining both clinical data and causes of death (COD), we gain a comprehensive understanding of the underlying issues and can strategize more effectively to reduce these preventable deaths.

Calculating Maternal Mortality Rates

The calculation of maternal mortality rates involves a detailed analysis of live births and maternal deaths within a specific timeframe. Health professionals and statisticians use the formula: Maternal Mortality Rate = (Maternal Deaths / Live Births) x 100,000. This calculation provides a standardized measure to compare across different regions and time periods. Accurate data collection from hospitals, health clinics, and registration systems is crucial for this calculation, ensuring that every maternal death is accounted for and categorized correctly between clinical diagnoses and cause of death data.

The Significance of Maternal Mortality Rates

Understanding the rate of maternal deaths per 100,000 live births is vital for health authorities and policymakers. This metric serves as a benchmark for maternal health globally, indicating the safety and quality of obstetric and prenatal care available to women. It also helps in identifying disparities in healthcare access and outcomes among different population groups, guiding targeted interventions. Moreover, tracking changes in this rate over time assists in evaluating the impact of health policies and programs aimed at improving maternal health.

Strengths and Limitations of Maternal Mortality Data

While maternal mortality rates are indispensable for health monitoring, they come with their own set of strengths and limitations.

Strengths

The primary strength of maternal mortality data lies in its ability to provide clear and actionable information to health policymakers and practitioners. It enables international comparisons and helps in tracking progress towards global health targets such as the Sustainable Development Goals (SDGs). Furthermore, this data is crucial for mobilizing resources and prioritizing health interventions that aim to reduce maternal deaths.

Limitations

However, the reliability of maternal mortality figures can be compromised by inconsistencies in data collection and reporting standards across different countries and regions. In some areas, underreporting of maternal deaths due to cultural stigmas or lack of medical certification can lead to inaccurate assessments of maternal health status. Additionally, the data does not account for indirect causes of maternal mortality, such as pre-existing medical conditions exacerbated by pregnancy, unless directly linked to maternal care. These limitations necessitate continuous efforts to improve data quality and reporting mechanisms to ensure that every maternal death is recorded and analyzed.

By addressing these challenges and leveraging the strengths of maternal mortality data, health systems worldwide can better protect maternal health and save lives. Continuous improvement in data accuracy and accessibility will empower more informed decision-making and ultimately lead to better health outcomes for mothers and their children.