The conceptual framework of the PMM Network.
Understanding the determinants of maternal mortality is a complex task, in part because maternal deaths are influenced by many different categories of events or conditions. Biology, economics, culture, demography and the distribution and effectiveness of health services all contribute. Conceptual frameworks have made important contributions to our understanding of the determinants of other, equally complex events, such as fertility and child survival. Also referred to as 'proximate determinants frameworks', such models are useful because they identify the specific mechanisms through which social, economic and cultural factors lead to the event of interest. Our model identifies the precise sequence of events that lead to maternal death (pregnancy, complication and death) and specifies categories of intermediate factors and distant factors that directly affect one or more of these events. When the world literature on maternal mortality was analyzed in light of the causal pathways laid out in the conceptual framework, it became clear that some pathways are more amenable to intervention and change than others. Implications for strategies, programs and monitoring and evaluation are discussed.
McCarthy
J
J
Center for Population and Family Health, Columbia University School of Public Health, New York, NY 10032, USA.
D000354:Africa, Western; D019058:Community Networks; D005260:Female; D006801:Humans; D007391:International Cooperation; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality; D017146:Models, Organizational; D011247:Pregnancy; D016730:Program Development