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Working towards a national Canadian surveillance system to reduce maternal mortality and morbidity

The Society of Obstetricians and Gynaecologists of Canada (SOGC) is hosting a national workshop in Toronto this week to improve deficiencies in tracking the incidence of maternal mortality and severe morbidity in Canada. The goal of the workshop is to develop a concrete strategy for the implementation of an identification, measurement, and national surveillance system. Experts from Canada and around the world will be in attendance, along with provincial and federal authorities. 

While Canada has a comparatively low rate of maternal mortality, recent reports are showing a slight increase. Women are entering pregnancy older, and may have more underlying health issues. We are dealing with new and aggressive bacteria, mental health concerns, substance abuse and interpersonal violence. The working definition of maternal mortality and morbidity in Canada does not capture all of these kinds of cases and, in the absence of a national strategy, it is difficult to conduct standardized investigations and reduce preventable deaths.  

As the causes of maternal death broaden, so must our thinking about when these cases occur. Women are not just at increased risk of death during pregnancy and in the first six weeks postpartum. Many jurisdictions and oversight bodies, including the World Health Organization (WHO), have extended their definition of maternal mortality and morbidity to include mental health, violence and accidents as examples of cases that have a negative impact on a woman’s well-being in the first year postpartum.  

“Provincial and territorial maternal death review committees and their scope vary greatly across the country, and we are not routinely asking on death certificates if a woman of childbearing age had been pregnant  during the preceding year,” says Dr. Jenifer Blake, CEO, SOGC. “But beyond the data reporting, we need a national standardized process to investigate maternal deaths that will help us take concrete actions to make pregnancy safer for women. We are lucky to have excellent maternal safety programs available across the country such as More OB and ALARM, but it is time now to put this next piece of the safety net into place.”

Canada falls behind other world leaders like the U.K., Australia and New Zealand, who have strong systems in place for monitoring, investigating and then acting on recommendations. The United States, who has also noted increasing rates of maternal deaths, has taken strong measures to improve the gaps and challenges in maternal mortality and morbidity data surveillance. Successful programs involve effective partnerships among government agencies, health care institutions, professional societies and leaders, health care professionals and pregnant women and their families.

“Gathering key Canadian decision-makers into the same room is an important first step towards our goal of providing the best care possible for every pregnant woman and her child in rural and urban communities across the country,” says Dr. Jocelynn Cook, Chief Scientific Officer, SOGC.  “There is an urgent need for health care providers to understand the underlying cause of death and preventable cases of maternal death in Canada. Canada can do better.”