Measuring and Understanding Maternal Mortality in Georgia

Understanding the level and causes of maternal death is a key for averting preventable death. Most of the major causes of maternal deaths can be prevented or treated with effective and timely clinical interventions, however, substandard quality care is the leading factor in two-thirds of maternal deaths in European countries. Furthermore, misclassification and/or misinterpretation of cause of death is a significant challenge. The aims of this thesis were to provide evidence on leading causes of death among women of reproductive age (WRA) in Georgia and burden of maternal disorders in overall mortality structure, as well as incidence, causes and level of underreporting of maternal mortality. Finally, the research identified key factors in substandard obstetric care contributing to maternal deaths. This was done by investigating of all causes of death to WRA through death identification, personal interviews with relatives of deceased women and medical record reviews. The findings of this research indicated non-communicable diseases to be the greatest threat for women’s health during fertile years. Cancer being the leading cause, and breast cancer remaining the principal cause of premature mortality, followed by injuries and cardiovascular diseases. The study documented 39.1% overall underreporting of maternal deaths by the official statistics, with late and indirect deaths being commonly unreported. The four leading causes were sepsis, hemorrhage, pulmonary embolism and preeclampsia/eclampsia. Suboptimal care, assumed to have made a difference to the outcome, was documented in 87% of early and 67% late maternal deaths due to direct obstetric causes. The gains observed in maternal health outcomes across Georgia will continue to require further improvements in quality and safety at multiple levels of the health system and advancing universal access to the provision of a quality of care before, during and after birth to eradicate preventable maternal deaths