Small Victories, New Challenges Two Decades of Maternal Mortality Surveillance in Jamaica

Objectives: The paper summarizes the changing epidemiology of maternal mortality and the new challenges as Jamaica seeks to contribute to the international goal to reduce maternal mortality by 75% worldwide between 1990 and 2015. Methods: This is a review of Jamaica's two decades of maternal mortality surveillance experience. Results: Jamaica began episodic reproductive age mortality surveys between 1981 and 1983. In order to move to continuous surveillance, maternal deaths were made a Class I notifiable event in 1998. Reporting has steadily improved with over 80% of deaths notified, however events in the first trimester and after the first week post-partum were less likely to be reported. While gestational hypertension remains the leading cause of death, the cause-specific mortality rate has declined in response to specific efforts to reduce its prevalence and consequences. Haemorrhage and infection also declined significantly in prevalence and rank. HIV disease moved rapidly to become the fourth-ranked cause of maternal death. Another lifestyle problem is the growing prevalence of obesity, with its contribution to deaths from heart disease, diabetes mellitus and gestational hypertension. A national maternal mortality surveillance committee has been established to monitor national trends and address policy issues. One of its first tasks will be to develop clinical guidelines to standardize management of the leading direct and indirect complications of pregnancy. Conclusion: Jamaica has the capacity to achieve MDG5, however, local and national maternal mortality committees and health teams will have to systematically address the deficiencies identified.