Evaluation of maternal death surveillance: a community process

The Mississippi State Department of Health found that the Centers for Disease Control and Prevention guidelines for evaluating surveillance systems could be used as a community approach in changing a maternal mortality surveillance system. This experience caused us to think more broadly about maternal mortality, challenge the guideline process, and ultimately embark on a new surveillance system. System changes included ensuring dissemination of findings, increasing number and type of stakeholders, including nonmedical factors, heightening awareness of maternal mortality, promoting timely reviews, reviewing our regulatory authority, adding field staff notification about maternal deaths, expanding the definition of maternal death, and combining surveillance systems-all of which leads to improved maternal mortality surveillance in Mississippi.