Maternal Death Reviews: Can Better Data Make Birth

What can maternal death reviews reveal that statistics miss?

WHO's call for stronger health information systems has a concrete application in maternity care: understanding why someone died and what might prevent a similar death. The SCORE technical package highlighted in the supplied news story was launched on August 27, 2020. Its recommendations include accurate death registration, reliable cause-of-death information and using evidence to improve services. Maternal death review provides a focused way to apply those principles. [WHO's SCORE announcement](https://www.who.int/news/item/27-08-2020-new-who-technical-package-health-data-for-covid-19-response).

The scale of the challenge remains substantial. WHO's April 2025 fact sheet estimated approximately 260,000 maternal deaths worldwide in 2023, despite a roughly 40% reduction in the global maternal mortality ratio between 2000 and 2023. Those figures describe the burden and its direction; they do not explain an individual patient's experience. [WHO maternal mortality fact sheet](https://www.who.int/news-room/fact-sheets/detail/maternal-mortality).

A review asks additional questions: Were complications recognized? Could the patient reach appropriate care? Was treatment available when needed? WHO's surveillance framework combines these circumstances with medical information so that services can identify changes relevant to their own patients. [WHO maternal death surveillance guidance](https://www.who.int/publications/i/item/9789241506083).

How can a maternal death review lead to safer care?

WHO's maternal and perinatal death surveillance and response approach links identifying deaths with investigating their causes and acting on modifiable contributing factors. An illustrative review of a death involving severe bleeding might examine recognition, escalation and access to treatment. These are questions for investigation, not assumptions about what caused any particular death. The aim is to establish where a practical change could reduce the likelihood of recurrence. [WHO implementation materials](https://www.who.int/publications/i/item/9789240036666).

The response needs to extend beyond a meeting or written recommendation. WHO's implementation resources describe assigning actions to responsible people or groups, setting completion dates and checking whether the actions occurred. Depending on the findings, a service might revise an escalation process or address a recurring referral delay. These examples illustrate possible responses; the appropriate intervention depends on the evidence collected locally. [WHO implementation toolkit](https://qualityhealthservices.who.int/quality-toolkit/qt-catalog-item/maternal-and-perinatal-death-surveillance-and-response-materials-to-support-implementation).

Confidentiality and a learning culture also matter. WHO recommends an approach that supports candid discussion while maintaining accountability for improvement. Completing reviews is a process measure; demonstrating safer care requires monitoring whether recommendations are implemented and whether relevant outcomes improve. [WHO implementation materials](https://www.who.int/publications/i/item/9789240036666).

Why do maternal death definitions matter when comparing results?

For standard international reporting, a maternal death occurs during pregnancy or within 42 days after pregnancy ends and results from a cause related to, or aggravated by, pregnancy or its management. Accidental or incidental causes are excluded. A late maternal death occurs from a direct or indirect obstetric cause more than 42 days but less than one year after pregnancy ends. These distinctions mean that the standard maternal mortality measure does not capture every pregnancy-associated death. [WHO maternal death definitions](https://www.who.int/data/gho/data/indicators/indicator-details/GHO/number-of-maternal-deaths).

WHO identifies underreporting and misclassification as important limitations of maternal mortality data. One implication is that better detection can increase recorded deaths without an equivalent increase in underlying risk. Conversely, an apparent decline deserves scrutiny if reporting has become less complete. Comparing services or tracking progress therefore requires consistent definitions, reliable birth counts and attention to changes in case identification. A review programme should be judged alongside these measurement issues, rather than by a single annual total. [WHO maternal mortality measurement guidance](https://data.who.int/indicators/i/AC597B1).