Measuring Maternal Mortality and Morbidity in Canada


      Maternal mortality and severe maternal morbidity are devastating for women, their families, and care providers. International efforts have been made to develop and to implement data collection, management, and surveillance systems that capture pregnancy-related information that can be assessed and used to improve health and system outcomes. At present, Canada does not have a national enquiry process to review maternal deaths, severe morbidity, and near misses, and has not set targets for maternal mortality reduction.
      Maternal mortality rates are critical measures of maternal health and provide important information for analysis of trends and priorities among and within countries. Information about near misses as well as maternal morbidity is crucial to truly understand and to prevent maternal mortality.
      Canadian experts must work together with governments, provinces, and territories to determine key indicators, measurement, and meaningful data analysis strategies. These data and their comparisons will form the foundation of evidence to guide programs, policies, priorities, and interventions that will ultimately improve the health of mothers and their children.


      La mortalité maternelle et la morbidité maternelle grave ont des répercussions terribles sur les femmes, les familles et les fournisseurs de soins. Partout sur la planète, on travaille à concevoir et à mettre en œuvre des systèmes de collecte de données, de prise en charge et de surveillance destinés à recueillir les données relatives aux grossesses pour qu'elles soient évaluées et qu'elles servent à améliorer la santé des patientes et les résultats du système de santé. À l'heure actuelle, le Canada ne s'est pas doté d'un processus d'enquête national pour étudier les décès maternels, la morbidité maternelle grave ainsi que les morbidités et les décès évités de justesse, et ne s'est pas fixé de cible pour la réduction de la mortalité maternelle.
      Le taux de mortalité maternelle, une mesure essentielle de la santé maternelle, fournit des renseignements importants pour l'analyse des tendances et des priorités nationales et internationales. Les renseignements sur les morbidités maternelles et les incidents évités de justesse sont indispensables pour bien comprendre et prévenir la mortalité maternelle.
      Les experts canadiens devront collaborer avec les gouvernements, les provinces et les territoires pour définir des indicateurs clés, déterminer des mesures et élaborer des stratégies concrètes d'analyse des données. Les données recueillies et leur comparaison à des valeurs de référence seront utilisées pour établir un cadre factuel guidant les politiques, les priorités, les interventions et les programmes qui permettront d'améliorer la santé des mères et de leurs enfants.

      Key Words


      APHP (Alberta Perinatal Health Program), BCPDR (British Columbia Perinatal Data Registry), BORN (Better Outcomes Registry & Network), CEMD (Confidential Enquiry into Maternal Death), CIHI (Canadian Institute of Health Information), CPSS (Canadian Perinatal Surveillance System), CRVS (civil registration and vital statistics), MDR (maternal death review), MDSR (Maternal Death Surveillance and Response), PHAC (Public Health Agency of Canada), PSBC (Perinatal Services British Columbia), UKOSS (United Kingdom Obstetric Surveillance System)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Nair M.
        • Nelson-Piercy C.
        • Knight M.
        Indirect maternal deaths: UK and global perspectives.
        Obstet Med. 2017; 10: 10-15
        • WHO
        • UNICEF
        • UNFPA
        • World Bank Group
        • United Nations Population Division
        Trends in maternal mortality: 1990 to 2015 [Internet].
        (World Health Organization; Available at:)
        • Graham W.
        • Woodd S.
        • Byass P.
        • et al.
        Diversity and divergence: the dynamic burden of poor maternal health.
        Lancet. 2016; 388: 2164-2175
        • Allen V.M.
        • Campbell M.
        • Carson G.
        • et al.
        Maternal mortality and severe maternal morbidity surveillance in Canada.
        J Obstet Gynaecol Can. 2010; 32: 1140-1146
        • World Health Organization
        Maternal mortality [Internet].
        (Geneva: World Health Organization; Available at:)
        Date: 2016
        Date accessed: January 15, 2017
        • Benoit C.
        Modern maternity care in Canada [Internet].
        (The Vanier Institute of the Family; Available at:)
        Date: 2015
        Date accessed: January 15, 2017
        • Public Health Agency of Canada
        Perinatal health indicators for Canada 2013: a report from the Canadian Perinatal Surveillance System.
        (December; Available at:)
        • World Health Organization
        • UNICEF
        • UNFPA
        • The World Bank
        • The United Nations Population Division
        Trends in maternal mortality: 1990 to 2013.
        (Available at:)
        • Allen V.M.
        • Baskett T.F.
        • O'Connell C.M.
        Contribution of select maternal groups to temporal trends in rates of caesarean section.
        J Obstet Gynaecol Can. 2010; 32: 633-641
        • Health Canada
        Special report on maternal mortality and severe morbidity in Canada.
        (Available at:)
        Date: 2004
        Date accessed: April 21, 2017
        • Verstraeten B.S.
        • Mijovic-Kondejewski J.
        • Takeda J.
        • et al.
        Canada's pregnancy-related mortality rates: doing well but room for improvement.
        Clin Invest Med. 2015; 38: E15-E22
        • BORN Ontario
        BORN Ontario.
        (About BORN [Internet]; Available at:)
        Date accessed: January 19, 2017
        • Provincial Perinatal Quality, Assurance Subcommittee, and Maternal Mortality Working Group
        Deaths of women during pregnancy, childbirth, and within one year after pregnancy: Alberta 1998–2011.
        Alberta Perinatal Health Program. Alberta Health Services, 2014
        • Provincial Health Services Authority
        Data & surveillance [Internet].
        (Perinatal Services BC; Available at:)
        • Farquharson D.
        Maternal mortality in British Columbia.
        (British Columbia Perinatal Health Program [Internet]; Available at:)
        • Reproductive Car Program of Nova Scotia
        The Nova Scotia Atlee perinatal database [Internet].
        (Reproductive Care Program of Nova Scotia; Available at:)
        Date accessed: January 20, 2017
        • IWK Health Centre
        • Reproductive Care Program of Nova Scotia
        • Dalhousie University
        Nova Scotia Atlee perinatal database report of indicators 2005–2014 [Internet].
        (Perinatal Epidemiology Research Unit; Available at:)
        • Knight M.
        • Lewis G.
        • Acosta C.D.
        • et al.
        Maternal near-miss case reviews: the UK approach.
        BJOG. 2014; 121: 112-116
        • California Department of Public Health
        Maternal mortality and the California pregnancy-Associated mortality review [Internet].
        (California Pregnancy-Associated Mortality Review; Available at:)
        • World Health Organization
        Maternal death surveillance and response: technical guidance information for action to prevent maternal death [Internet].
        (Geneva: World Health Organization; Available at:)
        • Kruk M.
        • Kujawski S.
        • Moyer C.
        • et al.
        Next generational maternal health: external shocks and health-system innovations.
        Lancet. 2016; 388: 2296-2306
        • Shaw D.
        • Guise J.M.
        • Shah N.
        • et al.
        Drivers of maternity care in high-income countries: can health systems support woman-centred care?.
        Lancet. 2016; 388: 2282-2295
        • Clark S.L.
        Strategies for reducing maternal mortality.
        Semin Perinatol. 2012; 36: 42-47