Maternal mortality ratio (MMR)

DefinitionThe number of women who die as a result of childbearing, during the pregnancy or within 42 days of delivery or termination of pregnancy in one year, per 100 000 live births during that year.

For the estimates from NCCEMD:
The confidential enquiry into maternal deaths system is not set up to determine the maternal mortality ratio (MMR) for a country.
Live birth data was obtained from the DHIS. It must to be noted that the confidential enquiry system is not designed for calculating ratios and rates. It is dependent on reporting; the more complete the reporting the more accurate the estimates of
the MMR. Provinces like the Free State and the Western Cape with good information systems reflect more accurate institutional MMRs. Comparisons between provinces cannot be made with respect to mortality ratios. Provinces, like the Free State, with good reporting systems, will have higher mortality ratios than provinces that report poorly. Comparison within the province is more interpretable, but will
also be confounded by the adequacy of reporting.
Keywords
Indicator Type: -> Health Status -> Reproductive Health -> Maternal health

[Related Resources]

Indicator Data
View by [Ethnic] [Geographic (SA provinces)] [International]

ECFSGPKZNLPMPNCNWWCZA
Maternal mortality ratio (MMR) [Definition]
1980 IHME (2010 estimates)---------[1] 208
1990 IHME (2010 estimates)---------[2] 121
1990 IHME (2011 estimates)---------[3] 119
1990 WHO (2010 estimates)---------[4] 230
1990 WHO (2012 estimates)---------[5] 250
1995 WHO (2010 estimates)---------[6] 260
1995 WHO (2012 estimates)---------[7] 260
1998 SADHS---------[8] 150
2000 CARe (Census 2001)---------[9] 575
2000 IHME (2010 estimates)---------[10] 155
2000 IHME (2011 estimates)---------[11] 89
2000 WHO (2003 estimates)---------[12] 230
2000 WHO (2010 estimates)---------[13] 380
2000 WHO (2012 estimates)---------[14] 330
2004 EDC---------[15] 147
2005 Hill et al---------[16] 400
2005 WHO (2010 estimates)---------[17] 440
2005 WHO (2012 estimates)---------[18] 360
2006 VR adjusted---------[19] 248
2007 VR adjusted---------[20] 310
2008 IHME (2010 estimates)---------[21] 237
2008 RMS 2012---------[22] 280
2008 VR adjusted---------[23] 310
2008 WHO (2010 estimates)---------[24] 410
2009 RMS 2012---------[25] 304
2009 VR adjusted---------[26] 333
2010 RMS 2012---------[27] 269
2010 WHO (2012 estimates)---------[28] 300
2011 IHME (2011 estimates)---------[29] 91
EC: Eastern Cape  FS: Free State  GP: Gauteng  KZN: KwaZulu-Natal  LP: Limpopo  MP: Mpumalanga  NC: Northern Cape  NW: North West  WC: Western Cape  ZA: South Africa  

Notes and References

  1. Lancet 375(1609-1623): Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5 [Internet]. Lancet. 2010;6736(10):1-15. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60518-1/fulltext
    Local copy: -
    Range of uncertainty: 131-316.
  2. IHME Maternal and Child Mortality: Hogan MC, Lopez A, Lozano R, Murray CJL, Naghavi M, Rajaratnam JK. Building Momentum: Global Progress toward reducing maternal and child mortality. Seattle: Institute for Health Metrics and Evaluation; 2010. http://www.healthmetricsandevaluation.org
    Local copy: /indicators/ChildHealth/IHME/IHME_Building_Momentum_2010.pdf
    Range of uncertainty: 73-190.
  3. Lozano et al. 2011: Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJ. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011;378:1139-65. http://www.ncbi.nlm.nih.gov/pubmed/21937100
    Local copy: -
  4. Maternal Mortality 1990-2008: WHO, UNICEF, UNFPA and The World Bank. Trends in Maternal Mortality: 1990 to 2008. Geneva: World Health Organization; 2010. http://www.who.int/reproductivehealth/publications/monitoring/9789241500265/en/
    Local copy: -
  5. Maternal Mortality 1990-2010: The Maternal Mortality Estimation Inter-Agency Group (MMEIG). Trends in maternal mortality: 1990 to 2010: WHO, UNICEF, UNFPA and the World Bank estimates. Geneva: World Health Organization; 2012. http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/index.html
    Local copy: -
  6. Maternal Mortality 1990-2008: WHO, UNICEF, UNFPA and The World Bank. Trends in Maternal Mortality: 1990 to 2008. Geneva: World Health Organization; 2010. http://www.who.int/reproductivehealth/publications/monitoring/9789241500265/en/
    Local copy: -
  7. Maternal Mortality 1990-2010: The Maternal Mortality Estimation Inter-Agency Group (MMEIG). Trends in maternal mortality: 1990 to 2010: WHO, UNICEF, UNFPA and the World Bank estimates. Geneva: World Health Organization; 2012. http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/index.html
    Local copy: -
  8. SADHS 1998: Department of Health, Medical Research Council & Measure DHS+. South Africa Demographic and Health Survey 1998, Full Report. Pretoria: National Department of Health; 2002. http://www.doh.gov.za/facts/1998/sadhs98/
    Local copy: /indicators/SADHS_1998_Full.pdf
    The 'big five' causes of maternal deaths in 1998 were complications of hypertensive conditions in pregnancy (23.2%), AIDS (14.5%), obstetric haemorrhage (13.3%), pregnancy related sepsis (11.9%) and pre-existing medical conditions, mainly pre-existing cardiac disease (10.4%). These five causes of deaths accounted for 73.3% of all the maternal deaths reported.
  9. CARe Mortality: Dorrington R, Moultrie TA, Timaeus IM. Estimation of mortality using the South African Census 2001 data. CARe Monograph No. 11. Cape Town: Centre for Actuarial Research; 2004. http://www.commerce.uct.ac.za/care/
    Local copy: /indicators/Population/CARe_mortality_Mono11.pdf
    The maternal mortality rate appears to be implausibly high at 575 per 100 000 births, however, this is only 6.5% of all deaths in the 15-49 age range which is well within the range of estimates from other sub-Saharan countries. On the other hand the high number could in part be attributable to the fact that a third of these deaths had age imputed, presumably on the basis of the cause of death, which might not have been universally correctly captured.
  10. IHME Maternal and Child Mortality: Hogan MC, Lopez A, Lozano R, Murray CJL, Naghavi M, Rajaratnam JK. Building Momentum: Global Progress toward reducing maternal and child mortality. Seattle: Institute for Health Metrics and Evaluation; 2010. http://www.healthmetricsandevaluation.org
    Local copy: /indicators/ChildHealth/IHME/IHME_Building_Momentum_2010.pdf
    Range of uncertainty: 95-248.
  11. Lozano et al. 2011: Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJ. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011;378:1139-65. http://www.ncbi.nlm.nih.gov/pubmed/21937100
    Local copy: -
  12. Maternal Mortality in 2000: AbouZahr C, Warklaw T, editors. Maternal Mortality in 2000: Estimates Developed by WHO, UNICEF and UNFPA. Geneva: WHO; 2003. http://www.childinfo.org/maternal_mortality_in_2000.pdf or http://www.who.int/reproductive-health/publications/maternal_mortality_2000/
    Local copy: /indicators/ReproHealth/maternal_mortality_in_2000.pdf
    Range of uncertainty: 58-430.
  13. Maternal Mortality 1990-2008: WHO, UNICEF, UNFPA and The World Bank. Trends in Maternal Mortality: 1990 to 2008. Geneva: World Health Organization; 2010. http://www.who.int/reproductivehealth/publications/monitoring/9789241500265/en/
    Local copy: -
  14. Maternal Mortality 1990-2010: The Maternal Mortality Estimation Inter-Agency Group (MMEIG). Trends in maternal mortality: 1990 to 2010: WHO, UNICEF, UNFPA and the World Bank estimates. Geneva: World Health Organization; 2012. http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/index.html
    Local copy: -
  15. Lancet 371(1294-304): South Africa Every Death Counts Writing Group. Every death counts: use of mortality audit data for decision making to save the lives of mothers, babies and children in South Africa. Lancet 2008; 371: 1294-304. http://www.thelancet.com/journals/lancet/article/PIIS0140673608605644/fulltext
    Local copy: /indicators/Journals/Lancet_371_1294.7z
    Based on Saving Mothers: Third Report on Confidential Enquiries into Maternal Deaths in South Africa, 2002-2004.
  16. Lancet 370(1311-19): Hill K, Thomas K, AbouZahr C, Walker N, Say L, Inoue M, et al. Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of available data. Lancet 2007; 370: 1311-19. http://www.thelancet.com/journals/lancet/article/PIIS0140673607615724/fulltext
    Local copy: /indicators/Journals/Lancet_MMR_v370_1311.pdf
    Calculated based on a model using the Census 2001 data on pregnancy-related deaths. Range of uncertainty 270-530.
  17. Maternal Mortality 1990-2008: WHO, UNICEF, UNFPA and The World Bank. Trends in Maternal Mortality: 1990 to 2008. Geneva: World Health Organization; 2010. http://www.who.int/reproductivehealth/publications/monitoring/9789241500265/en/
    Local copy: -
  18. Maternal Mortality 1990-2010: The Maternal Mortality Estimation Inter-Agency Group (MMEIG). Trends in maternal mortality: 1990 to 2010: WHO, UNICEF, UNFPA and the World Bank estimates. Geneva: World Health Organization; 2012. http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/index.html
    Local copy: -
  19. RMS 2011: Bradshaw D, Dorrington R, Laubscher R. Rapid mortality surveillance report 2011. Cape Town: South African Medical Research Council; 2012. http://www.mrc.ac.za
    Local copy: -
    The MMR is calculated (according to the method proposed by HDACC) from adjusted vital statistics by proportional redistribution of the ill-defined natural causes (ICD codes R00R99) among the specified natural causes. Thereafter, the number is adjusted to allow for the fact that about 7% of deaths are not registered.
  20. RMS 2011: Bradshaw D, Dorrington R, Laubscher R. Rapid mortality surveillance report 2011. Cape Town: South African Medical Research Council; 2012. http://www.mrc.ac.za
    Local copy: -
    The MMR is calculated (according to the method proposed by HDACC) from adjusted vital statistics by proportional redistribution of the ill-defined natural causes (ICD codes R00R99) among the specified natural causes. Thereafter, the number is adjusted to allow for the fact that about 7% of deaths are not registered.
  21. IHME Maternal and Child Mortality: Hogan MC, Lopez A, Lozano R, Murray CJL, Naghavi M, Rajaratnam JK. Building Momentum: Global Progress toward reducing maternal and child mortality. Seattle: Institute for Health Metrics and Evaluation; 2010. http://www.healthmetricsandevaluation.org
    Local copy: /indicators/ChildHealth/IHME/IHME_Building_Momentum_2010.pdf
    Range of uncertainty: 146-372.
  22. RMS 2012: Dorrington R, Bradshaw D, Laubscher R. Rapid mortality surveillance report 2012. Cape Town: South African Medical Research Council; 2014. http://www.mrc.ac.za/pressreleases/2014/8press2014.htm
    Local copy: -
  23. RMS 2011: Bradshaw D, Dorrington R, Laubscher R. Rapid mortality surveillance report 2011. Cape Town: South African Medical Research Council; 2012. http://www.mrc.ac.za
    Local copy: -
    The MMR is calculated (according to the method proposed by HDACC) from adjusted vital statistics by proportional redistribution of the ill-defined natural causes (ICD codes R00R99) among the specified natural causes. Thereafter, the number is adjusted to allow for the fact that about 7% of deaths are not registered.
  24. Maternal Mortality 1990-2008: WHO, UNICEF, UNFPA and The World Bank. Trends in Maternal Mortality: 1990 to 2008. Geneva: World Health Organization; 2010. http://www.who.int/reproductivehealth/publications/monitoring/9789241500265/en/
    Local copy: -
    Range of uncertainty: 240-610. Estimated proportion of maternal deaths due to HIV - 42.5%
  25. RMS 2012: Dorrington R, Bradshaw D, Laubscher R. Rapid mortality surveillance report 2012. Cape Town: South African Medical Research Council; 2014. http://www.mrc.ac.za/pressreleases/2014/8press2014.htm
    Local copy: -
  26. RMS 2011: Bradshaw D, Dorrington R, Laubscher R. Rapid mortality surveillance report 2011. Cape Town: South African Medical Research Council; 2012. http://www.mrc.ac.za
    Local copy: -
    The MMR is calculated (according to the method proposed by HDACC) from adjusted vital statistics by proportional redistribution of the ill-defined natural causes (ICD codes R00R99) among the specified natural causes. Thereafter, the number is adjusted to allow for the fact that about 7% of deaths are not registered.
  27. RMS 2012: Dorrington R, Bradshaw D, Laubscher R. Rapid mortality surveillance report 2012. Cape Town: South African Medical Research Council; 2014. http://www.mrc.ac.za/pressreleases/2014/8press2014.htm
    Local copy: -
    The MMR is calculated (according to the method proposed by HDACC) from adjusted vital statistics by proportional redistribution of the ill-defined natural causes (ICD codes R00R99) among the specified natural causes. Thereafter, the number is adjusted to allow for the fact that about 7% of deaths are not registered.
  28. Maternal Mortality 1990-2010: The Maternal Mortality Estimation Inter-Agency Group (MMEIG). Trends in maternal mortality: 1990 to 2010: WHO, UNICEF, UNFPA and the World Bank estimates. Geneva: World Health Organization; 2012. http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/index.html
    Local copy: -
  29. Lozano et al. 2011: Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, Dwyer-Lindgren L, Lofgren KT, Phillips D, Atkinson C, Lopez AD, Murray CJ. Progress towards Millennium Development Goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011;378:1139-65. http://www.ncbi.nlm.nih.gov/pubmed/21937100
    Local copy: -