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Research article

Why is it so difficult to report maternal deaths?

A thought-provoking paper by PhD candidate Andrea Melberg and colleagues underlines how the politicisation of global health initiatives affects the ways in which knowledge about important health indicators is produced.

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Andrea Melberg

The international community actively engages in initiatives to improve health in low and even middle-income countries.

To improve health systems, data needs to be collected that will identify gaps / problem areas. Such data could also be used to measure the effect of any changes in health care practices.

Under-reporting negative outcomes

In low-income settings, demonstrating progress in improving health outcomes has become an important way through which governments gain political legitimacy vis-à-vis their donors and the international health community. This politicising of health outcomes puts everyone involved in the health system - national and local governments, regional and local health centres - under tremendous pressure to deliver positive results. What does this mean in practice for the reporting of negative outcomes, or for the treatment of difficult cases?

A specific example

Andrea Melberg’s paper considers the example of maternal health in Ethiopia. Over the past 2 decades, there has been increased international focus on maternal health. It has been part of the United Nations’ Millennium Development Goals (MDGs) (adopted 2000 - Goal 5: to improve maternal health) and then the Sustainable Development Goals (SDGs) (adopted 2015 - target: By 2030, reducing global maternal mortality ration to less than 70 per 100 000 live births).

Ethical dilemma of target / indicator-driven funding practices

Melberg’s paper highlights this very real ethical dilemma. What if accurate data about maternal mortality is not actually being collected because of fears of possible adverse effects for the health workers and bureaucrats involved? Her example is taken from her PhD fieldwork conducted in Ethiopia. She concludes that “closer attention to the political context of death reporting and reviewing is necessary”.