Problems with Epidemiological Surveillance and Under-Reporting of Maternal Deaths in Yucatan, Mexico: An Analysis of Six Studies

Surveillance for maternal death cases remains a significant challenge for many countries worldwide. The importance of determining the actual magnitude of the global maternal mortality problem is reflected in the study and application of methodologies that attempt to approximate the actual number of deaths using several sources of information. Traditionally, death certificates have been the best source of data, but unfortunately the diagnoses recorded in them are not always accurate, with the unfortunate result in the under-reporting of maternal deaths. In Mexico, surveillance for cases of maternal deaths is conducted by examining the main cause of death recorded in death certificates. In some situations, the evaluation of the cause(s) of a mother death needs to be clarified, and the relatives are then interviewed. In Yucatan, six studies have been conducted to analyze the under-reporting of maternal deaths. The percentage of state under-reporting for the period between 1997 and 2001 was 19%. The rates of under-reporting varied between 10.5% and 28.6%, and it decreased to 3% in the eastern area between 2002 and 2010. The main causes of maternal death under-reporting were errors regarding the interpretation of the death diagnosis and the completion of the death certificate, as well as omissions when codifying, even though the pregnancy, delivery, or puerperium conditions had been recorded. Therefore, we recommend the establishment of an effective and highly functional maternal death surveillance system, including medical education and training of medical professionals to recognize the causes of maternal death and to prepare death certificates and training of the individuals responsible for coding obstetrical complications to include the correct interpretation of the causes.