Epidemiologic transition in maternal mortality and morbidity: New challenges for Jamaica

ObjectiveGiven interventions implemented in recent years to reduce maternal deaths, we sought to determine the incidence and causes of maternal deaths for 1998–2003.MethodRecords of public hospitals and state pathologists were reviewed to identify pregnancy-related deaths within 12 months of delivery and determine their underlying causes.ResultsMaternal mortality declined (p = 0.023) since surveillance began in 1981–83. The fall in direct mortality (p = 0.0003) included 24% fewer hypertension deaths (introduction of clinical guidelines, reorganization of antenatal services) and 36% fewer hemorrhage deaths (introduction of plasma expanders). These improvements were tempered by growing indirect mortality (p = 0.057), moving to 31% of maternal deaths from 17% in 1993–95.InterpretationDeclines in direct mortality may be associated with surveillance and related improvements in obstetric care. Increased indirect deaths from HIV/AIDS, cardiac disease, sickle cell disease and asthma suggests the need to improve collaboration with medical teams to implement guidelines to care for pregnant women with chronic diseases.