Maternal mortality in Argentina: a closer look at women who die outside of the health system.
OBJECTIVE
To assess maternal mortality among women who died outside health institutions. To use the technique of verbal autopsy to identify maternal deaths and to obtain qualitative information about the determinants of maternal death using the "three delays" model.


METHODS
Subjects were women aged 10-49 who died outside of a health institution during 2002 in five Argentine provinces with maternal mortality ratios above the national average. Cases were identified through the national and provincial registries, and data were collected using verbal autopsies, where the relatives of the deceased are interviewed.


RESULTS
Of 252 completed verbal autopsies, 15 maternal deaths and five late maternal deaths were found. Hemorrhage was the most common cause of maternal death. Seventy-nine percentage of women who died of maternal causes experienced at least one delay in accessing care, with delays in seeking assistance as the most common, followed by delays in accessing and receiving quality care.


CONCLUSIONS
Maternal causes of death are equally prevalent among women who die outside the health system as among those who die within it, but avoidable deaths are still a problem. Interventions to improve understanding of "alarm signals" (serious symptoms) and improved access and quality of care are necessary to reduce maternal mortality.
Rosenstein
Melissa G
MG
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Romero
Mariana
M
Ramos
Silvina
S
D000293:Adolescent; D000328:Adult; D001118:Argentina / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D003644:Death Certificates; D005190:Family; D005260:Female; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008428:Maternal Mortality; D008875:Middle Aged; D011247:Pregnancy; D055815:Young Adult
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