Background: Under-reporting and misclassification of maternal deaths are common, even in countries with a high quality of death statistics. The aims of this study were to determine to what extent maternal deaths are under-reported in Austria and to determine factors that might explain under-reporting.
Methods: Confidential enquiries on maternal deaths for the period 1980-98 were linked with the official mortality statistics from Statistics Austria. Maternal deaths were classified as direct and indirect obstetric deaths.
Results: Between 1980 and 1998 a total of 119 maternal deaths (112 direct and seven indirect obstetric deaths) were registered at Statistics Austria. Confidential inquiries into maternal deaths accumulated 191 maternal deaths (an additional 43 direct obstetric deaths and 29 indirect obstetric deaths). Total under-reporting was 38% (95% CI 31-45). Significantly more indirect obstetrical deaths were under-reported (81%; 95% CI 64-92) than direct obstetrical deaths (28%; 95% CI 21-36).
Conclusions: This study demonstrates the shortcomings of official registration of maternal deaths. Thus, maternal mortality cannot be seen as a reliable basis for health policy decisions.