Maternal Mortality Re-Visited in the AIDS Era: Brazzaville, 1996

This study provides an original method of analysing maternal mortality in Brazzaville, based on all deaths collected in the mortuaries in August 1996. During the study period, a clinical examination of all cadavers brought to Brazzaville's three mortuaries was done, and the relatives who had delivered the bodies were interviewed on signs and symptoms preceeding and the actual circumstances surrounding the deaths. A maternal mortality ratio of 652 per 100,000 was found in the age range 15 - 49 years, and the risk of death from all causes in women while pregnant, parturient or postpartum was estimated as double the baseline. The different indicators of risk of death attached to childbearing were shown to vary considerably according to age. In relative terms, the increase in all-cause risk of death was high for "early" pregnancies (estimated as nearly three fold below age 25), much more so for "late" pregnancies (nearly six fold above age 40), and much less for those pregnancies between these two age groups (less than two fold). In absolute terms, the excess risk of death associated with childbearing was maximum after (estimated at 40 per 1,000), and much lower before age 40 (5 to 6 per 1,000). In the age group most affected by AIDS (25 to 39 years), only 37% of all deaths in pregnant, parturient or postpartum women were from direct obstetric causes, versus about 60% before age 25 and 80% after age 40. The external and internal consistencies of the findings are discussed, and the public health policy implications are described.