1.

There should be a definition of maternal mortality and the indicator that is used for monitoring and reporting
should be specified. A summary of maternal mortality should be done separately for each country, and include
trends from 1990 to the most recent available year. There should be clear definitions of terms, and sources of
data clearly cited. The validity and comparability of the data should be assessed. The data should be nationally
representative, have a strong statistical underpinning and have clear methods written up and published. This
section should be 2-4 short paragraphs/ 150 - 300 words with maximum of 2 figures (newly drawn) as appropriate.

Maternal mortality refers to the death of a female during pregnancy or within 42 days post-partum, from causes
related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes1.

The maternal mortality ratio in India reduced from 556 per 100 000 live births in 1990 to 130 per 100 000 live
births in 20162. In the United States, the maternal mortality rate rose from 20.6 maternal deaths per 100,000
live births in 2008–2009 to 25.4 in 2013–20143.

2. The major determinants of maternal mortality for each country should include the common proximate causes
of death (where available), and underlying factors that have been identified. This section should be 2-4 short
paragraphs of 150 – 300 words. There should be clear reference to sources.

India2:
- Lack of access to quality maternal health services, such as for antenatal check-ups and tracking of high-
risk pregnancies
- Financial difficulties in obtaining supervised births
- Level of education and knowledge of females, to control their reproductive lives and marriage

United States4, 5:
- Lack of knowledge about warning signs and cardiovascular diseases in pregnancy
- Misdiagnosis
- Lack of coordination between health care professionals
- Race and ethnicity
- Insurance
- Level of education of females
3. A visual framework should show one or more underlying determinants of maternal mortality and suggest links
to immediate causes, using examples from one or both countries. This framework should be clearly laid out and
use visual cues (colour, shape, structure) to indicate significant determinants, how to read or follow the
framework, and contain enough detail to relate to the examples in part (2) and not just copying the general
framework without specificity. There should be a clear separation of concepts related to individual-level
proximate determinants (e.g. age, number of children, skilled attendance at birth), with wider and underlying
‘structural’ determinants (e.g. women’s status, accessibility of health facilities, social protection).

Lack of knowledge on high risk factors

Cultural factors
to look out for in pregnancy
Education policies
Education in females

Education in females
Socioeconomic status Access to health services

Government policies Financial difficulties in obtaining

quity healthcare
1. World Health Organization. International statistical classification of diseases and related health problems,
tenth revision. Geneva, Switzerland: World Health Organization; 1992.
2. https://www.who.int/southeastasia/news/detail/10-06-2018-india-has-achieved-groundbreaking-success-
in-reducing-maternal-mortality/
3. Trends in Maternal Mortality by Socio-Demographic Characteristics and Cause of Death in 27 States and the
District of Columbia
4. Wang E, Glazer KB, Howell EA, Janevic TM. Social Determinants of Pregnancy-Related Mortality and
Morbidity in the United States: A Systematic Review. Obstet Gynecol. 2020 Apr;135(4):896-915. doi:
10.1097/AOG.0000000000003762. PMID: 32168209; PMCID: PMC7104722.
5. Joseph KS, Boutin A, Lisonkova S, Muraca GM, Razaz N, John S, Mehrabadi A, Sabr Y, Ananth CV, Schisterman
E. Maternal Mortality in the United States: Recent Trends, Current Status, and Future Considerations. Obstet
Gynecol. 2021 May 1;137(5):763-771. doi: 10.1097/AOG.0000000000004361. PMID: 33831914; PMCID:
PMC8055191.