Long Read

Maternal Mortality Audits

The fifth Millennium Development Goal is to reduce the Maternal Mortality Ratio (MMR) by 75% between 1990 and 2015. Maternal deaths are defined as the number of women who die during pregnancy or within 42 days of the termination of pregnancy. However, accurate information on MMR is scarce and even in countries with adequate civil registration systems MMR is usually only measured at national level every five years. Special studies have revealed that about 50% of maternal deaths go unreported due to misclassifications.

A maternal mortality audit identifies different delays that cause maternal death. These can be: 1) A delay in deciding to seek medical care during pregnancy; 2) A delay in reaching the health facility on time; 3) A delay in receiving adequate health care services.

Icon_Maternal Mortality Audits

The Simavi Approach

Simavi supports community health care initiatives and promotes community based maternal mortality audits (also known as verbal autopsies) to prevent similar deaths in the future. This helps to:

– Provide real time information on the size of MMR in an area;
– Identify maternal deaths and their causes;
– Understand how practices leading to maternal mortality can be improved in the health facilities;
– Unravel how community practices contribute to this problem;
– Find solutions to improve maternal health.

Important characteristics

Volunteers or community health workers are trained to use verbal autopsy forms and conduct in-depth interviews and focus groups discussions. They contact resource people in the communities who can identify deaths among women aged 15-49 in a given period. Using the verbal autopsy form, the volunteers or community health workers interview family members to identify whether the death was related to the pregnancy. These cases are reviewed by a health professional to confirm the “maternal death” diagnosis. Finally, every story is documented in detail using in-depth interviews with family members.

The community-based audits are prepared both as a document and a publication – and both can be adapted to different target audiences. Causes related to the deaths are grouped and classified. The information is reported back to the affected communities, plus concerned health workers and authorities too. Simavi facilitates dialogue between these parties so that each group can look for solutions within their own roles and responsibilities to prevent future deaths. The involvement of community members strengthens their voice so that they can claim their rights and demand quality services from health providers and authorities. Additionally, information from the audits can be linked to national registration systems to retrieve accurate information on maternal deaths.


We are improving the awareness within communities on how they can prevent maternal deaths, and empowering individuals to claim their rights for quality SRHR services. We provide evidence on the causes of maternal deaths so that health authorities and service providers are held accountable for causes of poor performance or poor systems. This will improve the entire system and ultimately, maternal health.

For case studies and a more detailed explanation of how Simavi uses MMA to empower marginalised communities in Africa and Asia, please download our factsheet here.



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Do you want to know more about Maternal Mortality Audits?

Please contact our colleague Renate Douwes.

+31 (0)88 313 15 78