Sir, – John FitzGerald, in "Shedding light on inequalities in life expectancy" (January 13th), makes the oft-repeated error of asserting that Ireland's maternal death is three per 100,000; in fact the correct rate is close to three times higher than that, eight per 100,000, as found by the Maternal Death Enquiry Ireland, reporting in 2011 (and nine per 100,000 according to the UN).
For years Ireland’s maternal death rate was incorrectly under-reported both nationally and internationally. The reason for this was that in Ireland, figures were in years gone by not gathered accurately, in line with international standards as practised in countries like the UK. Figures here came directly from the CSO, whose information would come from death certificates only. The cause of death had to be cited as pregnancy or birth specifically on these for a death to be counted. In the majority of cases of maternal deaths, a death certificate will not record exactly this and thus these cases were not recorded by the CSO, skewing the results for Ireland dramatically.
As per the World Health Organisation definition, maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.
These figures are now being reported for Ireland in line with international best practice, as a result of the effort put into this important work by the Maternal Death Enquiry (MDE) based in UCC. However even the MDE itself points out that the true figure for Ireland is still probably unknown, as a review of MDE cases to date has shown that “pregnancy status [on the Medical Death Notification Form, filled out by a medical practitioner to report a death] has not been correctly completed in some cases”.
For developed countries with access to healthcare, nutrition, hygiene, and technology, it is more appropriate to measure safety not only in terms of death but also the “near-misses” and serious health implications to mothers and babies as a result of birth (morbidity) – both physical and psychological. – Yours, etc,
SINÉAD REDMOND,
Association for the
Improvement in
Maternity Services,
Celbridge, Co Kildare.