Lifetime risk of maternal mortality in Zambia using census data

Richard Banda, University of Bergen
Knut Fylkesnes, University of Bergen
Ingvild Sandøy, University of Bergen

Background: The risk of death from pregnancy-related causes is rarely considered in interventions to reduce maternal mortality. Focus has centred on the maternal mortality ratio, which does not portray a complete picture of mortality associated with childbearing and is not useful in targeting interventions. Methods: We used pregnancy-related deaths captured in the Zambia 2010 census to estimate the lifetime risk of death from pregnancy-related causes. Age-specific maternal mortality rates were used to obtain direct estimates of lifetime risk in the absence of competing causes for infant survivors to adolescent and to age 49. We applied life table survival ratios to age specific maternal mortality rates in estimating lifetime risk with competing causes of death. Results: In the absence of competing causes, one in every 23 girls born in Zambia and surviving to adolescence will die from a pregnancy-related cause during her reproductive life course, with higher risk for girls born in rural areas (one in every 20) than urban areas (one in every 31). When competing causes of death are factored into the estimation, the risk of death from a pregnancy-related cause drops to one in every 33 female infants. However rural-urban differential remain, with one in every 28 female infants born in rural and one in every 43 female infants born in urban at risk of a pregnancy-related death. Adolescents in rural areas have twice the lifetime risk of their urban peers, while the risk is highest in women aged 30-34. Conclusion: Safe motherhood remains a distant reality for most women in Zambia. The risk of a pregnancy-related death is very high even when other causes of death are considered. There is need to use a combination of indicators to measure the impact of interventions to reduce maternal mortality. Key words: Pregnancy-related deaths, lifetime risk, census, maternal mortality, Zambia