Maternal Mortality in Los Altos de Chiapas. Validation of an Alternative Indicator for Identifying Under-Registration of Maternal Death in Indigenous Regions

Abstract

In certain indigenous regions of Mexico –with rugged mountains and scattered popula­tions, such as Los Altos de Chiapas– maternal mortality continues to be under-registered (MM). Through the complementary use of quantitative and qualitative information, the research project sought to construct indicators that would permit the alternative identi­fication of this phenomenon in high-risk municipalities.

This paper presents and discusses an alternative indicator to the mm ratio, to recognize the high risk of dying during maternity of a set population. It is an “inequity index” constructed on the basis of reproductive-age female mortality, the general mortal­ity rate and the ratio between the sexes. Validation of the proposal is based on a trans­versal study carried out in 17 municipalities in the region, and the follow-up of 226 deaths of women ages 15 to 49, identified through the Civil Registry. Verbal autopsies conducted on 190 of these cases revealed the under-registration of MM in the region in 2001. Poor registration was analyzed on the basis of an alternative index constructed on the assumption that in places where there is female over-mortality compared with the rest of the state and the mortality ratio by sexes differs sharply from the state average, women are more vulnerable than their peers in other municipalities, meaning that MM may be under-registered. Under-registration is directly and proportionately linked to the index. No under-registration of MM was found in the municipalities with the lowest index. Conversely, 50% under-registration was observed in those with a medium index while 76% was observed in municipalities with a higher index.