Demographic and Health Survey 2009-10 - Timor-Leste Ministry of ...

ADULT AND MATERNAL MORTALITY 9
The Safe Motherhood Initiative, launched in 1987, drew increased worldwide attention to
reproductive health, as did the need for reliable countrywide estimates of maternal deaths. In response
to this increased interest, DHS surveys began collecting maternal mortality data through a series of
questions designed to obtain a direct measure of maternal mortality. More recently, in an effort to
improve global health, the United Nations Development Program initiated the Millennium
Development Goals (MDG), with Goal 5 focused on the reduction of maternal mortality by threequarters
between 1990 and 2015. The government of Timor-Leste hopes that its strong commitment to
a reproductive health strategy, a national family planning policy, training for health providers on safe,
clean deliveries and emergency obstetric care, and the equipping of established health facilities will
result in a reduction in the maternal mortality ratio (MMR) to 252 deaths per 100,000 by the year
2015 from a baseline estimate of 660 in 2000 (UNDP and the Government of Timor-Leste, 2009).
Estimates of maternal mortality in Timor-Leste have ranged from a low of 380 deaths per
100,000 live births to a high of 880 deaths per 100,000 live births (HAI, 2010). Data from WHO,
UNICEF, UNFPA, and the World Bank for 2005 indicate that the MMR is 380 deaths per 100,000
live births (WHO et al., 2004). In 2008, WHO, UNICEF, UNFPA, and the World Bank estimated,
from reports by national authorities, an adjusted maternal mortality ratio of 370 per 100,000 women
and a lifetime risk of 1 in 44 deaths to women from maternal causes (WHO et al., 2010). These
various model-based estimates of MMR are extrapolated from indirect estimates of other published
health-related information.
Estimating maternal mortality requires a comprehensive and accurate reporting of maternal
deaths. Data from the 2009-10 TLDHS provides for the first time a direct estimate of maternal
mortality from a population-based survey. The data presented in this chapter will play a vital role in
filling the need for a reliable national estimate of maternal mortality. Nevertheless, it is important for
users of this information to understand the inherent problems associated with measuring maternal
mortality in general if they are to avoid misinterpretation of the survey results. This holds particularly
true when comparing results obtained from other indirect and model-based estimates.
Direct estimates of maternal mortality use data on the age of surviving sisters of survey
respondents, the age at death of sisters who have died, and the number of years that have passed since
the deaths of sisters.
9.1 DATA QUALITY ANALYSIS
To obtain the sibling history, each respondent was first asked to give the total number of her
mother’s live births. The respondent was then asked to provide a list of all of the children born to her
mother, starting with the first-born and the first-born’s survival status at the time of the interview. For
living siblings, the current age was collected. For deceased siblings, the age at death and years since
death were collected. Interviewers were carefully instructed to obtain precise information wherever
possible, and when respondents were unable to provide exact age at death or years since death,
particularly in the case of events that occurred decades ago, approximate but quantitative answers
were accepted. For sisters who died at age 12 and above, three additional questions were asked:
whether the sister was pregnant at the time of death, whether she died during childbirth, and whether
she died within two months of the end of a pregnancy or childbirth. Listing all siblings in
chronological order of their birth is believed to result in better reporting of events than would be the
case if the interviewer obtained only information on sisters. Moreover, the information collected also
allows direct estimates of adult male and female mortality.
Adult and Maternal Mortality | 109