ABSTRACT
Developing countries which have somewhat reliable vital statistics but poor or incomplete information about maternal mortality must make the most of the data available. Such data may require modification for maternal mortality analyses. What is important, however, is the decision to use available information and to analyse it properly. The analysis of maternal mortality in Guatemala, using data from 1986 birth and death certificates, identified particular areas, health regions, and particular ethnic groups that had significantly higher maternal mortality ratios than others. Small but disproportionately affected populations that had no available maternal health assistance were identified-a problem found in many developing countries. These groups urgently need the services of traditional birth attendants or other forms of assistance before, during and after delivery. The analysis of vital statistics led to the beginning of operative research and the collection of background information for establishing an epidemiologic surveillance programme for maternal mortality.
PIP: Guatemala vital statistics data on maternal mortality from official sources is variable. Generally about 5% of all deaths among women 10-49 years old are attributed to maternal mortality. This analysis of birth and death certificates for 1986 reveals a J-shaped curve for the maternal mortality ratio by age. The indigenous population had higher rates in all departments. The highest maternal mortality ratio (MMR) in 22 departments was in the department of Alta Verapaz (214.2/100,000 live births). The lowest MMR was found in Progreso department. The MMR in 1986 was calculated as 132.5/100,000 live births for Guatemala, or 1 pregnant woman's death every day. Among 8 health regions, the northern health region had the highest MMR (213.3/100,000). The metropolitan region had the lowest MMR (84.9/100,000). Hospital deliveries ranged from 4.7% for the northwest region to 70.7% for the metropolitan region. MMR was found to decrease by about 1/100,000 for every increase in the percentage of hospital-based deliveries, with the exception of the indigenous population, where MMR increased for every 1% increase in hospital-based deliveries. MMR was higher in hospitals for most regions. Births without medical assistance in 6 out of 8 regions had higher MMRs. For example in the northern region MMR for births without assistance was 3539.8/100,000. 5.5% of Guatemalan women had no assistance with deliveries (98 deaths out of 17,532 live births). Physician-attended deliveries had a MMR of 91.5/100,000, and traditional birth attendant-deliveries had a MMR of 96.6/100,000. In 1986 a UN assessment team found registrations reasonably completed, and estimates of registration were determined to be about 90%. Problems in recording may be due to the absence of any reference to a pregnancy on the death certificate, or the absence of the final cause or autopsy findings on the death certificate.