The decline in maternal mortality has been associated with a growing interest in maternal
morbidity over the past two decades. Maternal mortality is the tip of the iceberg of maternal
morbidity. However, assessment of maternal morbidity is not easy and comparability of available
studies is hampered by the different study designs, the lack of a uniform definition of what
constitutes maternal morbidity, the variability in severity of individual morbidities, and the lack of
a standard data collection tool.
In Jordan, there is limited information on maternal morbidity. The present study is the first
comprehensive assessment of maternal morbidity at the national level and hopefully will be useful
for policy development, planning, assessment of progress, and program evaluation.
Study Objectives:
1- To determine the overall incidence of maternal morbidity.
2- To identify the spectrum of maternal morbidity and the incidence of the main diseases and
complications.
3- To identify possible discrepancies in maternal morbidity among the three regions and the
different health sectors in Jordan.
4- To assess potential risk factors and predictors of maternal morbidity, such as parity, age,
educational level, and employment status.
5- To explore potential limitations in offering high quality services to clients with maternal
morbidity in various health care facilities.
6- To report on the incidence and complications of miscarriage.
Study Design:
A cohort design was used to achieve the above objectives. A national sample of pregnant women was
enrolled before their twenty second week of gestation between January 15 and April 15, 2007 and followed
up throughout pregnancy, labor, and post partum. A total of 4,501 women were finally included in the study
(about 10% of the eligible pregnant women in the country during the period of recruitment) with a response
rate over 81%. A structured questionnaire and data sheet were developed for the purpose of this study; and
a group of experts in the field assessed the study instrument for content validity. A total of 80 physicians,
72 of whom were obstetricians from various health sectors and governorates, were responsible for
completing the questionnaire and data sheet for their patients. The principal investigators visited the study
sites and held meetings with the study teams of physicians. During these meetings, the principal investigators
discussed relevant issues including the purpose of the study, the study protocol, the study instrument, data
confidentiality, and the timeframe for reporting. Adherence to the study protocol, answering all questions,
and encouraging the study teams to contact the study investigators for any inquiry or clarification were
stressed and achieved. The principal investigators were actively involved in the monitoring progress through
telephone calls and/or site visits as needed throughout the study period.