Sex and Gender-based Analysis of this topic
Definition
Maternal mortality is defined as the death of a woman during pregnancy or within 42 days of the termination of the pregnancy. Deaths are included regardless of the duration and the site of the pregnancy (including ectopic pregnancies) and from any cause related to or aggravated by the pregnancy or its management. Deaths from accidental or incidental causes are not included in these figures [1]. The maternal mortality rate for any given country is considered a basic measurement of the country’s women’s health services, indicating access to health care services and quality of perinatal services [2]. Maternal mortality rates are typically measured by the maternal mortality ratio (MMR), which is the number of maternal deaths per 100,000 live births. The worldwide MMR in 2000 was around 400 [3]. In Canada, from 2002-2004, it was estimated at 5.8 [4]. The MMR for British Columbia from 2000 to 2006 was 7.8 [5].
Sex Issues
The leading causes for maternal mortality in Canada are pulmonary embolism and preeclampsia/pregnancy-induced hypertension, amniotic fluid embolism, and intracranial hemorrhage [6]. Specific biological conditions, such as obesity, hypertension, and pre-existing chronic conditions are linked to an increased maternal mortality rate. For the years 1997-2000, over 50% of the indirect maternal deaths in Canada were caused by pre-existing cardiovascular conditions [5, 7].
Gender Issues
Maternal mortality tends to cluster along strongly gendered characteristics, which are not evenly distributed across the Canadian population. For example, women with low socio-economic status are at higher risk for prenatal stress and are less likely to initiate pre-natal care, both of which negatively impact pregnancy outcomes and increase the risk for maternal mortality [8]. Additionally, average maternal age is advancing, as well as the use of assisted conception techniques that increase the rate of multiple births, both of which are associated with higher rates of maternal mortality [9-10].
Diversity
Significant gaps exist in maternal mortality data for specific vulnerable populations within Canada, including Aboriginal women, low socioeconomic groups, and recent immigrants to Canada [7]. Part of the challenge comes from the rarity of maternal mortality in Canada, which makes determining risks in subpopulations statistically difficult. The limited data that do exist indicate that Aboriginal women are at nearly twice the risk for maternal mortality compared to the overall Canadian population [11].
Critique
Globally, there has been a number of documented issues with underreporting and misclassificationof maternal deaths [3]. In 2004, the Canadian Perinatal Surveillance System conducted a review of Canadian maternal mortality statistics and found a similar issue of underreporting [4]. Additionally, due to the variety of systems used to report maternal mortality in the Canadian provinces, comparisons of trends across the provinces are limited and should be done with caution [7]. Surveillance mechanisms should be enhanced and standardized to limit underreporting, including utilization of in-depth case investigations and reporting.
Although Canada has one of the lowest reported maternal mortality ratios in the world, it is important to capture the differing rate of maternal mortality in specific subpopulations such as Aboriginal and immigrant women. Reporting in this detail is not currently available. And although maternal mortality is an effective proxy measure of women’s healthcare services on a population level, it may need to be supplemented with other more direct measurements to properly gauge services for specific groups.