A Strategy for the Evaluation of Activities To Reduce Maternal Mortality in Developing Countries

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Abstract
The expense and effort involved in collecting the data necessary for calculating maternal mor tality rates and ratios often discourages efforts to evaluate projects. The use of a set of care fully selected process indicators is presented as a practical alternative. The evaluation strategy proposed is based upon a recently published conceptual framework of maternal mortality. The strategy includes four stages: (1) outlining the causal pathway through which an intervention is hypothesized to work; (2) determining how the pathway will be affected by external factors; (3) developing indicators at each step of the pathway; and (4) selecting a combination of indicators that together will provide sufficient evidence that the intervention was successful. This process is illustrated for three program interventions: providing safe abortion services, increasing knowledge of obstetric complications, and improving quality of medical care.