What National Programs Should Do to Reduce Maternal Mortality

John Ross, Futures Group International
Rodolfo A. Bulatao, National Academies
John Stover, Futures Group International

We describe a model to help in planning national maternal health services in developing countries. The model shows how maternal mortality responds to changes in services, rated by experts on an 81-item questionnaire labeled the Maternal and Neonatal Program Index (MNPI). These service ratings, cross-national regressions show, are related to maternal mortality (as are income and education). The model uses these equations and also assumes interdependence among different services. Such support functions as budget and training, for instance, affect the capacity of health facilities, which relates to the adequacy of care they provide, with consequences for women's access to essential care. Health services are also distinguished by objective: treatment, risk identification, prevention, and avoidance of risky pregnancies or births. The model calculates the impact on maternal mortality of changes in service ratings and indicates how the major causes of maternal mortality may be affected.