Zambia

The MMR for women who delivered in health facilities declined by 35%, from 534 to 345 maternal deaths per 100,000 live births.

Although maternal mortality from all direct obstetric causes declined substantially, the largest declines were likely due to improvements in access to and utilization of timely, goodquality obstetric care, including life-saving surgical interventions and availability of medications, such as antibiotics and uterotonics.

To document change in maternal mortality during Phase 1 of the SMGL initiative, the Zambia SMGL team reviewed medical records in health facilities in SMGL-supported districts. These records were supplemented by information about facility deaths from a census conducted shortly before Phase 1 began (baseline data) and from pregnancy tracking conducted by community key informants. Data from these sources revealed the following: „ The MMR for facilities in SMGLsupported districts declined by 35%, from 310 to 202 maternal deaths per 100,000 live births in health facilities. „ Information was lacking on the number of nonfacility maternal deaths during the endline period, which prevented the calculation of mortality levels or changes for the districts as a whole. However, the high rate of deliveries in health facilities (84%) and the high percentage of maternal deaths that took place in facilities at baseline (70%), coupled with a substantial reduction in MMR in facilities, strongly suggest a decline in the district-wide level of maternal mortality. „ Maternal mortality in health facilities from major direct obstetric causes declined.

Among all direct causes of maternal death, the largest declines occurred for the following causes: ◊ Obstructed labor, including uterine rupture (78% decline in cause-specific MMR). ◊ Obstetric hemorrhage (34% decline in cause-specific MMR).

These causes were addressed by SMGL interventions. These trends suggest that there were improvements in the access to and utilization of timely, good quality obstetric care.