title: Constructing maternal morbidity - towards a standard tool to measure and monitor maternal health beyond mortality.
abstract: BACKGROUND
  Maternal morbidity is a complex entity and its presentation and severity are on a spectrum. This paper describes the conceptualization and development of a definition for maternal morbidity, and the framework for its measurement: the maternal morbidity matrix, which is the foundation for measuring maternal morbidity, thus, the assessment tool.
  
  
  CONCLUSIONS
  We define maternal morbidity and associated disability as "any health condition attributed to and/or complicating pregnancy and childbirth that has a negative impact on the woman's wellbeing and/or functioning." A matrix of 121 conditions was generated through expert meetings, review of the International Classification of Diseases and related health problems (ICD-10), literature reviews, applying the definition of maternal morbidity and a cut-off of >0.1% prevalence. This matrix has three dimensions: identified morbidity category, reported functioning impact and maternal history. The identification criteria for morbidity include 58 symptoms, 29 signs, 44 investigations and 35 management strategies; these criteria are aimed at recognizing the medical condition, or the functional impact/disability component that will capture the negative impact experienced by the woman. The maternal morbidity matrix is a practical framework for assessing maternal morbidity beyond near-miss. In light of the emerging attention to Universal Health Coverage (UHC) as part of the post-2015 Sustainable Development Goals (SDGs) planning, a definition and standard identification criteria are essential to measuring its extent and impact.
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. choud@who.int.
authors.forename: Doris
authors.initials: D
authors.lastname: Chou
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. tuncalpo@who.int.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: University of British Columbia, Vancouver, Canada. tabassum@interchange.ubc.ca.
authors.forename: Tabassum
authors.initials: T
authors.lastname: Firoz
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. barreixm@who.int.
authors.forename: Maria
authors.initials: M
authors.lastname: Barreix
authors.affiliation: St. George's, University of London, London, UK. veronique.filippi@lshtm.ac.uk.
authors.forename: Veronique
authors.initials: V
authors.lastname: Filippi
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK. pvd@sgul.ac.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK. Nynke.vandenBroek@lstmed.ac.uk.
authors.forename: Nynke
authors.initials: N
authors.lastname: van den Broek
authors.affiliation: UNICAMP, Faculdade de Ciências Médicas, Caixa Postal 6030, 13081-970, Campinas, SP, Brazil. cecatti@unicamp.br.
authors.forename: Jose Guilherme
authors.initials: JG
authors.lastname: Cecatti
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. sayl@who.int.
authors.forename: Lale
authors.initials: L
authors.lastname: Say
mesh_terms: D005260:Female; D006801:Humans; D000068097:Maternal Health / Q000145:classification / Q000592:standards*; D009017:Morbidity; D011247:Pregnancy; D011248:Pregnancy Complications; D009626:Terminology as Topic