Safe motherhood in the United States: challenges for surveillance.
OBJECTIVE
Maternal mortality ratios in the United States are higher than those of many other industrialized nations. Moreover, these ratios have not changed in the past 20 years, and large racial disparities persist in measures of both maternal mortality and morbidity. In an affluent developed country, maternal deaths should serve as rare sentinel events, highlighting opportunities for prevention and reduction of morbidities. However, existing surveillance efforts are poorly developed, and pregnancy-related deaths and illnesses tend to be underreported. To formulate recommendations for improved surveillance, the authors reviewed existing data on maternal health.


METHODS
This review examines the scope and quality of existing information and the strengths and limitations of definitions of maternal mortality and morbidity used in data collection and reporting.


RESULTS
This review suggests numerous gaps in surveillance of U.S. maternal health. Psychological as well as physical morbidity, and the presence and adequacy of appropriate treatment, should be ascertained. Quality of pregnancy-related care at the clinical and community levels, and the impact on mortality and morbidity, must be assessed. Collection of morbidity data outside of health care delivery sites is also essential. Trade-offs between nationally representative and other less comprehensive data sources, such as sentinel clinics, large healthcare organizations, and public healthcare financing systems, should be considered.


CONCLUSIONS
Maternal health remains an important frontier for U.S. public health surveillance efforts. Improved surveillance offers opportunities for reducing pregnancy-related mortality and gaining a better understanding of the relationship between maternal morbidity and mortality.
Bennett
Trude A
TA
Department of Maternal and Child Health, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7445, USA. trude_bennett@unc.edu
Adams
Melissa M
MM
D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D040361:Healthy People Programs; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality; D008429:Maternal Welfare / Q000208:ethnology; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology / Q000517:prevention & control; D040442:Public Health Informatics; D011785:Quality Assurance, Health Care; D017751:Safety Management; D014481:United States / Q000453:epidemiology