4.2 % of maternal deaths among adolescents in targeted areas
The purpose of this indicator is to measure the maternal mortality rate among adolescents. See indicator 4.1 for guidance, and calculate the % of adolenscents among the maternal mortality rate.
Vital registration, health service records, household surveys, census.
How to Collect
Measuring maternal mortality accurately is difficult except where comprehensive registration of deaths and of causes of death exists. Elsewhere, census, surveys or models have to be used to estimate levels of maternal mortality. Population based surveys are the primary source of information for calculating the maternal mortality ratio in many developing countries. These types of surveys include:
RAMOS (Reproductive Age Mortality Surveys) studies seek to identify all female deaths in the reproductive period, using a combination of approaches, such as cross-sectional household surveys, continuous population surveillance, hospital and health center records, and key informants (WHO, 1987).
Direct Estimation relies on asking questions about maternal deaths in a household during a recent interval of time, say one to two years. These questions can be asked in the context of a household survey or a census of all households, although as yet experience with the latter is fairly limited (Campbell, 1999).
Both these types of methods provide up-to-date estimates but are time-consuming and costly because they require large sample sizes to obtain single-point estimates with sufficiently narrow confidence intervals to enable monitoring of time trends.
The sisterhood method goes some way to overcoming large sample size requirements by interviewing adult respondents about the survival of all their sisters. The indirect method (Graham, Brass, and Snow, 1989) involves fewer questions to respondents but provides a pooled estimate that relates statistically to a point around 10-12 years prior to the survey. The direct method (Stanton, Abderrahim, and Hill, 2000) provides a more current estimate at about 3-4 years prior to the survey, but requires more questions and is more costly and time consuming.
Maternal mortality ratios are only a broad indication of the level of maternal mortality, rather than a precise measure, because of the limitations inherent in most measurement methods.
How to analyse
The % of maternal deaths among adolescent girls is calculated by deriving the % of adolescents for the MMR under indicator 4.1