Maternal mortality is the most sensitive measure of health system quality available. Where it is high, the health system is failing its most basic test.
Why Maternal Mortality Is the Measure
Maternal mortality — the death of a woman during pregnancy or childbirth — is the health outcome most sensitive to the quality of the health system's essential components: the availability of skilled attendance at birth, the quality of emergency obstetric care, the accessibility of health facilities across the full geographic and socioeconomic range of the population, and the responsiveness of the health system to the specific needs of women at their most vulnerable. Because maternal mortality is the product of all these system dimensions simultaneously, it reflects overall health system quality with a sensitivity that single-disease indicators cannot match.
The Preventability Problem
Most maternal deaths are preventable with interventions that are well-established and relatively inexpensive: skilled attendance at birth, access to emergency obstetric care within a reasonable distance of where women give birth, and antenatal care that identifies and manages high-risk pregnancies before they become emergencies. The persistence of high maternal mortality rates in specific countries and communities is therefore not a technical problem — the solutions are known — but a governance problem: the failure to ensure that the known solutions are accessible to the women who need them.
Maternal mortality is the health system's report card. Where it is high, the system is not providing the basic functions that a functional health system is supposed to provide to women during pregnancy and childbirth. The number is not statistical — it is each of the individual women whose death the system was capable of preventing and did not.
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