Decennial Census
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A national population census involves collecting, evaluating, analysing and disseminating demographic and socio-economic data on all persons in a country (or in a well-delimited part of a country) at a specified time. Most countries do a national census every 10 years.
Where countries already ask about deaths in the household in the year before the census (or some other reference period), adding questions on whether the deaths were pregnancy-related can be an efficient way to get national and subnational estimates of maternal mortality, including the proportion of maternal deaths among female deaths (PMDF), the maternal mortality ratio (MMR), the maternal mortality rate (MMRate) and the lifetime risk of maternal death (LTR).
However, if the census is used for the measurement of maternal mortality, it is essential that these data be evaluated and adjusted, if necessary. Demographic techniques have been developed to adjust for under/over reporting of births (reverse projection techniques or parity to cumulated fertility ratios) and deaths (growth balance).
Data requirements include:
- the distribution of the male and female population by age
- the distribution of male and female deaths by age (preferably from the current and the previous census)
- the number of live children ever born by age of woman
- the number of live births in the household during the year preceding the census
Adult household members retrospectively report to the enumerator the age and sex of all household members who have died within a specified period, usually 1 or 2 years prior to the census. These are referred to as the Direct Mortality Questions.
Ascertainment of maternal/pregnancy related status:For all female deaths to women aged 15-49 identified in the household, an adult respondent reports if the death occurred during pregnancy, childbirth or within the six weeks following the termination of the pregnancy. This series of questions is referred to as Pregnancy-related Questions.
Advantages:
- it is a routine undertaking every 10 years (with the possibility of every five years if there is a large inter-censal survey)
- estimates are more recent than those resulting from many other methods of maternal mortality measurement (the reference period for maternal mortality estimates from the census is generally one to two years before the census)
- the census provides data on births, deaths and socio-economic characteristics of the household for the entire population - enabling reporting of maternal mortality by urban/rural residence, region and other socio-economic characteristics
- the addition of pregnancy-related questions lengthens the duration of the census interview only negligibly
Limitations:
- it is a large-scale undertaking
- data processing for the census may take considerable time
- it will not give detailed causes of maternal death (without the addition of a later, separate interview including verbal autopsies)
- space on the questionnaire may be limited
- training of enumerators may be poor
- disintegration of households after death can mean there is no “household” to report the death
- there are no standard measures for quantifying uncertainty due to non-sampling errors, and currently methods have yet to be developed to quantify uncertainty of the adjusted estimates of maternal mortality
Census Questions
When information is collected on household deaths (by age and sex) in the past 12 months (or some other reference period), the following question is asked for any woman who died between the ages of 15 and 49:
- Did the death occur while she was pregnant, during childbirth or during the six weeks (40 days) after the end of pregnancy?
The ideal response is “yes/no”, however the only available answer may be “unknown” or “not sure”. *
Alternatively, this question can be broken into parts, which may be easier to understand:
- Did the death occur while she was pregnant? (“yes/no”; “unknown/not sure”)
- Did the death occur during childbirth (“yes/no”; “unknown/not sure”)
- Did the death occur during the six weeks (40 days) after the end of pregnancy (“yes/no”; “unknown/not sure”)
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Hill K, Stanton C, Gupta N (2001) Measuring maternal mortality from a census: Guidelines for potential users. Chapel Hill: MEASURE Evaluation |
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