The primary aim of this paper is to highlight the usefulness of differentiating between direct and indirect maternal deaths in ensuring the effective and reliable monitoring and evaluation of interventions for reducing mortality. Interventions such as the provision of skilled birth attendants and emergency obstetric care, while crucial in tackling the direct causes of maternal death, are unlikely to have a preventative or therapeutic effect on indirect causes unless a woman presents with a complication from an indirect cause during labour. Our hypothesis is that the failure to differentiate between direct and indirect maternal deaths may lead to inaccurate evaluations of interventions and underestimates of their effects because causes of death that are not targeted by a particular intervention may be included when measuring its effect. Furthermore, the need to provide additional or alternative interventions to combat indirect maternal death may remain obscured if the outcome being evaluated is only all-cause maternal death.
Bulletin of the World Health Organization (2010) 88:147-153. [doi: 10.2471/BLT.09.063537]
What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries.