147Bull World Health Organ 2010;88:147–153 | doi:10.2471/BLT.09.063537

Policy & practice What you count is what you target: the implications of maternal death classification for tracking progress towards reducing maternal mortality in developing countries Suzanne Cross,a Jacqueline S Bell a & Wendy J Grahama Abstract The first target of the fifth United Nations Millennium Development Goal is to reduce maternal mortality by 75 % between 1990 and 2015. This target is critically off track. Despite difficulties inherent in measuring maternal mortality, interventions aimed at reducing it must be monitored and evaluated to determine the most effective strategies in different contexts. In some contexts, the direct causes of maternal death, such as haemorrhage and sepsis, predominate and can be tackled effectively through providing access to skilled birth attendance and emergency obstetric care. In others, indirect causes of maternal death, such as HIV/AIDS and malaria, make a significant contribution and require alternative interventions. Methods of planning and evaluating maternal health interventions that do not differentiate between direct and indirect maternal deaths may lead to unrealistic expectations of effectiveness or mask progress in tackling specific causes. Furthermore, the need for additional or alternative interventions to tackle the causes of indirect maternal death may not be recognized if all-cause maternal death is used as the sole outcome indicator. This article illustrates the importance of differentiating between direct and indirect maternal deaths by analysing historical data fro