How well do our vital statistics and national surveys measure Maternal Mortality Ratios
(MMR) over time?
For the past 25 years, our Maternal Mortality Ratios have remained unchanged. This
observation is curious given that so many interventions to improve prenatal care,
attendance at delivery by a skilled birth attendant, and post-partum care have been put
in place by both national and local governments. In reality, facility-based delivery is
now at 80% on average. The question is therefore raised on whether there is in fact no
change in MMR or whether the current methods to measure MMR are statistically
adequate to detect any changes.
To answer the aforementioned question, the authors examined the quality of Vital
Statistics 2010-2014 by analyzing the public use files provided by the Philippine
Statistics Authority. The authors concluded that data quality was poor based on the low
coverage of maternal death reports, the incompleteness of entries, and the lack of
internal consistency in the reporting of immediate, antecedent, and underlying causes
of death. Thus these could not be relied upon for MMR estimates.
On the other hand, national surveys have also been incapable of detecting any
changes in MMR over the last 25 years due to the lac of statistical power. In other
words, sample sizes were not large enough to detect changes less than +/-40 per
100,000 and to increase them was unaffordable. Furthermore, the inherent limitation
of the sisterhood method used in these surveys added to the uncertainty of the
estimates of MMR.
Moving forward, striving to improve the quality Civil Registry and Vital Statistics is the
path which the Philippines should take. This effort should be pursued diligently in the
coming years. In the meantime, as far as the MMR baseline for the Sustainable
Development Goal is concerned, the country is constrained to use the FHS 2011 figure
of 221 per 100,000 as the point of reference for 2030. The country should aim to have
reliable maternal mortality estimates from the Vital Statistics within the next few years
and certainly before 2030.