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Stud Fam Plann. 1996 Jan-Feb;27(1):29-35.

Issues in measuring maternal morbidity: lessons from the Philippines Safe Motherhood Survey Project.

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Demographic and Health Surveys (DHS) Program, Macro International, Inc., Calverton, MD 20705, USA.


This report explores the limitations of survey research for obtaining population-based data to define the magnitude of maternal morbidity in settings that lack a well-developed infrastructure to support women's health requirements. The experience gained in the Philippines Safe Motherhood Survey Project is described. The drawbacks and benefits of the preliminary validation and qualitative phase of research conducted to develop the questionnaire are presented. The survey results indicate that interview-based diagnosis, although it implies the commitment of considerable resources, may be the only way to obtain an idea of the prevalence of some kinds of maternal morbidity in a given population, information necessary to the improvement of obstetric care and women's overall health status.


The major goal of the 1993 Philippines Safe Motherhood Survey (SMS) was to determine the prevalence of key obstetric complications and to describe related patterns of health service use. Validation and qualitative research helped in development of the final SMS questionnaire. The SMS was one of few studies that have tried to provide population-based data on specific issues of maternal health. There are no standard and accepted data collection techniques for maternal health as there are for the study of fertility and child health. Validation studies help quantify the sensitivity and specificity of interview questions about selected symptoms of obstetric complications, while qualitative research provides insight into women's own perceptions about their experiences as well as some of the sociocultural issues influencing their reports. The findings from these preliminary studies and the SMS suggest that interview-based diagnosis of obstetric complications is the only method of obtaining any indication of how prevalent maternal morbidity is among women within a population. Interviews do require considerable resources, however. For example, in the Philippines, 4-5 months of intensive activity took place before implementation of the standard pretest, interviewer training, and survey fieldwork. This intensive activity involved an epidemiologist and a social scientist with qualitative research skills, both of whom might not normally participate in a Demographic and Health Survey-type survey. Yet this information is needed to improve obstetric care and women's overall health status.

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