Abstract
Objectives To assess maternal mortality among women who died outside health institutions. To use the technique of verbal autopsy to identify maternal deaths and to obtain qualitative information about the determinants of maternal death using the “three delays” model. Methods Subjects were women aged 10–49 who died outside of a health institution during 2002 in five Argentine provinces with maternal mortality ratios above the national average. Cases were identified through the national and provincial registries, and data were collected using verbal autopsies, where the relatives of the deceased are interviewed. Results Of 252 completed verbal autopsies, 15 maternal deaths and five late maternal deaths were found. Hemorrhage was the most common cause of maternal death. Seventy-nine percentage of women who died of maternal causes experienced at least one delay in accessing care, with delays in seeking assistance as the most common, followed by delays in accessing and receiving quality care. Conclusions Maternal causes of death are equally prevalent among women who die outside the health system as among those who die within it, but avoidable deaths are still a problem. Interventions to improve understanding of “alarm signals” (serious symptoms) and improved access and quality of care are necessary to reduce maternal mortality.
Similar content being viewed by others
References
Ministerio de Salud de la Nación, Programa Nacional de Estadísticas de Salud. Estadísticas Vitales—Información Básica 2002. (2003). [National Ministry of Health, National Statistics Program. Vital Statistics, Basic Information 2002]. Buenos Aires, Argentina.
World Health Organization. (2004). Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. Geneva, Switzerland.
World Health Organization. (2006). World Health Statistics 2006. Geneva, Switzerland.
Verbal autopsies for maternal deaths. (1995). Report of a WHO Workshop, London, 10–13 January 1994. Geneva: World Health Organization. WHO document WHO/FHE/MSM/95.15.
World Health Organization. (2004). Beyond the numbers. Geneva: WHO.
Bartlett, L. A., Mawji, S., Whitehead, S., Crouse, C., Dalil, S., Ionete, D., Salama, P., & the Afghan Maternal Mortality Study Team. (2005). Where giving birth is a forecast of death: Maternal mortality in four districts of Afghanistan, 1999–2002. Lancet, 365, 864–70.
Ramos, S., Karolinski, A., Romero, M., Mercer, R., & for the Maternal Mortality in Argentina Study Group. (2007). A comprehensive assessment of maternal deaths in Argentina: Translating multicentre collaborative research into action. Bulletin of the World Health Organization, 85, 615–622.
McCarthy, J., & Maine, D. (1992). A framework for analyzing the determinants of maternal mortality. Studies in Family Planning, 23, 22–33.
Walker, D., Campero, L., Espinoza, H., Hernández, B., Anaya, L., Reynoso, S., & Langer, A. (2004). Deaths from complications of unsafe abortion: Misclassified second trimester deaths. Reproductive Health Matters, 12(24 Suppl.), 27–38.
Oates, M. (2003). Perinatal psychiatric disorders: A leading cause of maternal mortality and morbidity. British Medical Bulletin, 67, 219–229.
Campero, L., Walker, D., Hernández, B., Espinoza, H., Reynoso, S., & Langer, A. (2006). La contribución de la violencia a la mortalidad materna en Morelos, México. [The contribution of violence to maternal mortality in Morelos, Mexico]. Salud Pública de México, 48(Suppl. 1), S105–S114.
Frautschi, S., Cerulli, A., & Maine, D. (1994). Suicide during pregnancy and its neglect as a component of maternal mortality. International Journal of Gynecology and Obstetrics, 47, 275–284.
Why Mothers Die 2000–2002—Report on confidential enquiries into maternal deaths in the United Kingdom. CEMACH, London, 2004.
Chandramohan, D., Soleman, N., Shibuya, K., & Porter, J. (2005). Ethical issues in the application of verbal autopsies in mortality surveillance systems. Tropical Medicine and International Health, 10, 1087–1089.
World Health Organization. (1992). International statistical classification of diseases and related problems, 10th revision. Geneva: WHO.
Ministerio de Salud y Acción Social-Secretaría de Salud- OPS/OMS. Estudio de la mortalidad materna. Análisis del subregistro de las muertes maternas en Capital Federal (1985). [Ministry of Health and Social Action, Secretariat of Health, PAHO/WHO. An investigation of maternal mortality: Analysis of maternal death under-registration in Buenos Aires] Dirección Nacional de Maternidad e Infancia, Dirección de Estadísticas de Salud. Buenos Aires, Argentina; 1989.
Horon, I. L. (2005). Underreporting of maternal deaths on death certificates and the magnitude of the problem of maternal mortality. American Journal of Public Heath, 95, 478–482.
Turner, L. A., Cyr, M., Kinch, R. A. H., Liston, R., Kramer, M. S., Fair, M., & Heaman, M. (2002). Under-reporting of maternal mortality in Canada: A question of definition. Chronic Diseases in Canada, 23, 22–30.
Pan-American Health Organization. (2001). Profile of the health services system: Argentina. Washington, DC: PAHO.
Acknowledgements
The authors are grateful to the families who participated in the verbal autopsies. They also thank the local researchers, Sofía Amenabar, Gustavo Agolti, Carlos Cardello, María Graciela Sarmiento and Oscar Federico as well as the interviewers. Silvia Fernández and Mónica Molinas helped with the coordination of the field work. Finally, this project could not have been possible without the support of the National Ministry of Health and its Research Unit (CONAPRIS), the United Nations Population Fund (UNFPA) and the Pan American Health Organization (PAHO).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rosenstein, M.G., Romero, M. & Ramos, S. Maternal Mortality in Argentina: A Closer Look at Women Who Die Outside of the Health System. Matern Child Health J 12, 519–524 (2008). https://doi.org/10.1007/s10995-007-0268-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-007-0268-2