Indicator 3.1.1 Maternal mortality ratio

SDG 3: Good Health and Well-being: Ensure healthy lives and promote well-being for all at all ages

3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.

3.1.1 Maternal mortality ratio per 100,000 population of age

Maternal mortality ratio

23 June 2021

Lao Statistics Bureau

Mr.Vilaysook SISOULATH

Department of Social Statistics

Deputy Director General

+856 20 55 795 043

+856 21 214 740

vilaysooks@gmail.com

lstats@lsb.gov.la

Definition:

The maternal mortality ratio (MMR) is defined as the number of maternal deaths during a given time period per 100,000 live births during the same time period. It depicts the risk of maternal death relative to the number of live births and essentially captures the risk of death in a single pregnancy or a single live birth.

Concepts:

Maternal deaths: The annual number of female deaths from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, expressed per 100,000 live births, for a specified time period.

per 100,000 population

The Lao Social Indicator Survey II (LSIS II) and the Population and Housing Census (PHC)

The Lao Social Indicator Survey II (LSIS II) was carried out in 2017 by Lao Statistics Bureau (LSB) in collaboration with the Ministry of Health and Ministry of Education and Sport, as part of the Global Multiple Indicator Cluster Survey (MICS) Programme. Data are collected through household survey-anthropometric measurement.

Sampling approach: Two-stage, stratified cluster sampling.

Questionnaires:

Type of interview: Face-to-face. MICS survey utilized Computer-Assisted Personal Interviewing (CAPI) starting in 2017 round.

Fieldwork duration: July to November 2017

Data processing. The data collection application was based on the CSPro (Census and Survey Processing System) software, Version 6.3, including a MICS dedicated data management platform. Procedures and standard programs2 developed under the global MICS programme and adapted to the LSIS II, 2017 questionnaire were used throughout. The CAPI application was tested in Vientiane Capital and Vientiane Province in January. Based on the results of the CAPI-test, modifications were made to the questionnaires and application.

Training: Training for the fieldwork was conducted for 31 days between June and July 2017. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Participants first completed full training on paper questionnaires, followed by training on the CAPI application. The trainees spent three days in field practice and one day on a full pilot survey in Vientiane province. The training agenda was based on the standard MICS6 training agenda.

Enumerators (data collectors) received dedicated training on anthropometric measurements and water quality testing for a total of seven days, including three days in field practice and pilot survey. Field Supervisors attended additional training on the duties of team supervision and responsibilities.

Fieldwork: The data were collected by 25 teams; each was comprised of four interviewers, one driver, two measurers and a supervisor. Fieldwork began in July 2017 and concluded in November 2017. Data was collected using tablet computers running the Windows 10 operating system, utilising a Bluetooth data transfer application for field operations, enabling transfer of assignments and completed questionnaires between supervisor’s and interviewer’s tablets.

For detailed methodology, please see the survey report.

(Link provided in the reference section).

Data are collected through household survey-anthropometric measurement.

The Lao Social Indicator Survey II (LSIS II) was carried out in 2017 by Lao Statistics Bureau (LSB) in collaboration with the Ministry of Health and Ministry of Education and Sport, as part of the Global Multiple Indicator Cluster Survey (MICS) Programme.

Sampling approach: Two-stage, stratified cluster sampling.

Questionnaires:

Type of interview: Face-to-face. MICS survey utilized Computer-Assisted Personal Interviewing (CAPI) starting in 2017 round.

Fieldwork duration: July to November 2017

Data processing. The data collection application was based on the CSPro (Census and Survey Processing System) software, Version 6.3, including a MICS dedicated data management platform. Procedures and standard programs2 developed under the global MICS programme and adapted to the LSIS II, 2017 questionnaire were used throughout. The CAPI application was tested in Vientiane Capital and Vientiane Province in January. Based on the results of the CAPI-test, modifications were made to the questionnaires and application.

Training: Training for the fieldwork was conducted for 31 days between June and July 2017. Training included lectures on interviewing techniques and the contents of the questionnaires, and mock interviews between trainees to gain practice in asking questions. Participants first completed full training on paper questionnaires, followed by training on the CAPI application. The trainees spent three days in field practice and one day on a full pilot survey in Vientiane province. The training agenda was based on the standard MICS6 training agenda.

Enumerators (data collectors) received dedicated training on anthropometric measurements and water quality testing for a total of seven days, including three days in field practice and pilot survey. Field Supervisors attended additional training on the duties of team supervision and responsibilities.

Fieldwork: The data were collected by 25 teams; each was comprised of four interviewers, one driver, two measurers and a supervisor. Fieldwork began in July 2017 and concluded in November 2017. Data was collected using tablet computers running the Windows 10 operating system, utilising a Bluetooth data transfer application for field operations, enabling transfer of assignments and completed questionnaires between supervisor’s and interviewer’s tablets.

For detailed methodology, please see the survey report.

(Link provided in the reference section).

Every five years, next collection period will be from July to November 2022

one year after the reference year, next release will be in November 2023

Lao Statistics Bureau

Lao Statistics Bureau

Data collection, processing, dissemination and use of statistics for this indicator is in accordance with the Statistics Law 2017; the National Strategy for Sustainable Development of Statistical System (NSSDSS) 2016-2020; and the Vision for 2030

All maternal mortality indicators derived from the 2017 estimation round include a point-estimate and an 80% uncertainty interval (UI). Data are available and can be downloaded from the webpage “maternal mortality – levels and trends 2000-2017: http://mmr2017.srhr.org. Both point-estimates and 80% UIs should be considered when assessing estimates.

For example:

Say the estimated 2017 MMR is 211 (UI 199 to 243)

This means:

• The point-estimate is 211 and the 80% uncertainty interval ranges 199 to 243.

• There is a 50% chance that the true 2017 MMR lies above 211, and a 50% chance that the true value lies below 211.

• There is an 80% chance that the true 2017 MMR lies between 199 and 243.

• There is still a 10% chance that the true 2017 MMR lies above 243, and a 10% chance that the true value lies below 199.

Other accurate interpretations include:

• We are 90% certain that the true 2017 MMR is at least 199.

• We are 90% certain that the true 2017 MMR is 243 or less.

The amount of data available for estimating an indicator and the quality of that data determine the width of an indicator’s UI. As data availability and quality improve, the certainty increases that an indicator’s true value lies close to the point-estimate.

The extent of maternal mortality in a population is essentially the combination of two factors:

i. The risk of death in a single pregnancy or a single live birth.

ii. The fertility level (i.e. the number of pregnancies or births that are experienced by women of reproductive age).

Survey estimates come with levels of uncertainty due to both sampling error and non-sampling error (e.g. mesasurement technical error, recording error etc.,). Caveats and limitations inherent to survey data applies.

The maternal mortality ratio can be calculated by dividing recorded (or estimated) maternal deaths by total recorded (or estimated) live births in the same period and multiplying by 100,000.

Measurement requires information on pregnancy status, timing of death (during pregnancy, childbirth, or within 42 days of termination of pregnancy), and cause of death.

Standard data review and validation protocols were implemented from data collection, processing, calculation to finalization and publication of the results of the survey.

Likewise, consultation process with line ministries and partner agencies on the national data submitted for the SDGs Indicators were conducted prior to the publication of results

Managing the quality of the indicator is guided by the Lao PDR Statistics Law of 2017 and in accordance with the recommendations of the UN Fundamental Principles of Official Statistics.

Team supervisors were responsible for the daily monitoring of fieldwork. Mandatory re-interviewing was implemented on one household per cluster. Daily observations of interviewer skills and performance was conducted. During the fieldwork period, each team was visited multiple times by survey management team members and field visits were arranged.

Throughout the fieldwork, field check tables (FCTs) were produced weekly for analysis and action with field teams. The FCTs were customized versions of the standard tables produced by the MICS Programme.

These steps are taken to ensure quality of outputs produced is at par with international standards.

In general, the quality of the survey results is considered high given the quality management and standards implemented along with the high response rates for all age groups covered in the basic data source used for obtaining the value for this SDG indicator

LSIS has been conducted at five-year intervals since 2011-2012. Hence, data are available for 2012 and 2017.

Disaggregated by Location (U/R), Provinces.

The Lao Social Indicator Survey II, 2017
https://www.unicef.org/laos/media/306/file/LSIS2017ENG.pdf

The UNSD SDG Indicators, Metadata repository https://unstats.un.org/sdgs/metadata/

Lao PDR Statistics Law, 2017
https://www.lsb.gov.la