Tuesday, 13 January 2015

Ireland's Maternal Death Rate - Depends on who you are asking.

In Today's Irish Times, John Fitzgerald shares a piece on CSO statistics for Ireland called, ‘Vital Statistics’ sheds light on inequalities in life expectancy”. The articles states, "While the death rate also fell in the Republic, it was not till the late 1970s that it reached the UK level. Today, in spite of recent tragedies that have received significant media attention, the maternal death rate is very low, at about three per 100,000 births, marginally lower than that in Northern Ireland, England and Wales."

Once again AIMS Ireland need to highlight that CSO figures for maternal death of 3 per 100,000 are inaccurate and under-reported. More accurate figures, using a more appropriate, broader classification system on par with other EU countries, show a very different story.

 One of these stats is not like the other

The recent United Nations Population Fund (UNFPA) report put Ireland's maternal death rate at 9 per 100,000. (Irish Independent)

The Maternal Death Enquiry (MDE) Ireland has reported a rate of 8 per 100,000 in their recent report with specific mention to issues in the classification and collection of data, with general hospitals and the Irish coroner system both cited as areas which lead to under-reporting. As described here in the most recent MDE Ireland report (2009-2011):
"In Ireland, the Medical Death Notification Form completed by a medical practitioner contains
a question “If the deceased was female, was she known to have been pregnant at the time of
death, or within the previous 42 days?” (Answer “yes” or “no” in all cases)13. The Coroner’s
certificate does not contain this question.

In the case of Death Notification Forms, a review of MDE cases to date has shown that the
question on pregnancy status has been not being correctly completed in some cases. Review
of death certificates issued by the GRO office, following receipt of a Coroner’s certificate,dentified information on current or recent pregnancy was absent in many cases of indirect
maternal deaths. These issues clearly impact on ascertainment of reliable maternal mortality
From MDE Ireland's 2009-2011 report regarding CSO figures:
"Comparative available data for the years 2009 and 2010 showed that all but one maternal
direct death was identified by the CSO. However, none of the thirteen indirect or six
coincidental maternal deaths were identified by the CSO."

Despite these noted inaccuracies, flaws and numerous reports of Ireland's true maternal death rate, it is the CSO figures which are regularly quoted by Government and Political representatives. We've all heard the 'Ireland is the safest place to have a baby' speeches, however, what most of us don't realise is that that with a maternal death rate of 8 per 100,000 we are on par with many of our EU counterparts and actually ranks worse than others. For example:

France 8 per 100,000
UK 10 per 100,000
Germany 7 per 100,000
Belgium 5 per 100,000

AIMS Ireland's position:
Calculations for a Nation's Maternal Death rate is an international standard for measuring safety in maternal health services, however, AIMS Ireland feel this statistic alone does not provide full insight into safety of care provided to mothers and babies. As a developed Western nation, with access to ante-natal care, nutrition, hygiene, and technology, it is more appropriate to measure safety not only in terms of death but also the 'near misses' and serious health implications to mothers and babies as a result of a pregnancy/birth (morbidity) - both physical and psychological.
From the Irish Times, 13/1/2015 regarding CSO figures:
UNFPA rates - Irish Independent 19/11/2014
Maternal Death Enquiry Ireland (MDE Ireland) 2009-2011 report:

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