Misreporting of maternal mortality in Puerto Rico

Maternal mortality (MM) continues to be a problem that plagues many developed and underdeveloped countries around the world. It has been estimated that the minimum amount of underreporting in the U.S. to be 20%, resulting in MM rates that may be substantially higher than reported. The national goal for the MM for the year 1990 has been set at 5/100,000, and at the present trend it is expected that this may be achieved among the white population, but not among minorities. P.R. reported a maternal mortality rate of 5/100,000 in 1975. It was suspected that such a low rate was due to underreporting, a study was undertaken to investigate that possibility. The results indicated that there was severe underreporting of maternal deaths during 1978 = 79. Recently, there has been a growing concern that the level of underreporting in PR continues to be high. Since there has been no evidence that the surveillance has improved, the Dept. of Health requested from the Dept. of Ob-Gyn of the University of Puerto Rico Medical School and the Dept. of Maternal and Child Health to conduct a study to find out if the previous findings held true for recent years. The study was based on the review of selected medical records corresponding to deaths of women of childbearing age whose causes of death, as coded in the death certificate, were considered as having a high probability of masking a misreported maternal death. It was decided to investigate those deaths occurring in 1982, to see if the results of the previous study had caused any impact on the surveillance of maternal deaths in Puerto Rico.