Maternal Mortality Ratio Estimates Region of the Americas

Geneva, Jan 2011

Fatima Marinho, MD, PhD

Coordinator of Information and Health Analysis

Pan American Health

Organizationmarinhof@paho.org

MMR. Estimation for the Americas

• Completeness adjustments• The use of the correction factor (CF) of 1.5 and the generalized

application for VR data is problematic.• For those countries with better registration systems (e.g. Canada,

Uruguay, Cuba, Chile) CF causes an artificial increase in MMR and benefits the ones with less quality of vital registration (e g. Guatemala, Belize and Suriname).

• The CF of 1.5 has been applied over 18 years (1990-2008) without any consideration that many countries in this region have improved their vital registration system, especially since 2000. The CF should decrease over time.

• This is the case of Uruguay, Argentina and Mexico. It is very hard to accept the inconsistency between the latest 2005 WHO estimate and the new one, e.g Mexico. In the latter publication, Mexico’s important progress has been started in 2002 and was recognized by WHO while this time it was not considered.

Results• When we compare the results for the countries in the Americas, we

find some inconsistencies. We expect the MMR to be lower for some countries than for others and vice-versa. For some countries, the estimates underestimate or overestimate the MMR.

• The statistics model shows a strong tendency to decrease the MMR of those countries which began with high MMR in 1990 (Bolivia and Haiti) and a steady decrease tendency in those which presents initial lower MMR (Puerto Rico). It might suggest that the model could be better adjusted to reflect the differences in the trends among those countries.

• Haiti’s MMR is low; probably due to the HIV prevalence adjustment• We also consider Suriname MMR very low.• We do not agree that the following countries Argentina, Canada,

Chile, Costa Rica, Cuba, Chile, Mexico, Uruguay, and USA have to be corrected by CF 1.5.

• We expect that the MMR of Argentina, Brazil, Venezuela and Mexico are more proximate.

RMM. Países del GRUPO 1.

0

10

20

30

40

50

60

70

IHME PAHO WHO UNICEF UNFPA WB

CHI URUCUB COR

MMR Comparison of different sources

RMM. Países del GRUPO 2.

0

50

100

150

200

250

IHME PAHO WHO UNICEF UNFPA WB

PANARGVENCOLMEXELSBRADOR

RMM. Países del GRUPO 3.

0

50

100

150

200

250

300

IHME PAHO WHO UNICEF UNFPA WB

NICECUPARGUTPERHON

RMM. Haití y Bolivia.

0

100

200

300

400

500

600

700

800

900

1000

IHME PAHO WHO UNICEF UNFPA WB

BOLHAI

RMM for Suriname

SUR. MMR Estimations.

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0

IHME

Lower MMR

Upper MMR

PAHO

WHO UNICEF UNFPAWB

Thank you!

Merci! Gracias! Obrigada!