The Bali Indirect Maternal Mortality Study (BIMMS) was conducted in Bali Province, Indonesia in 1991. The objective of the study was to evaluate the indirect sisterhood method for estimating maternal mortality, using a prospective (direct) community-based survey undertaken from 1980 to 1982 among women of reproductive age (Reproductive Age Mortality Survey, or RAMOS) as a comparison. The BIMMS maternal mortality ratio was 331 per 100,000 live births adjusted for 1982. This ratio is similar to the RAMOS one prior to its adjustment, of 359 per 100,000 live births. The sisterhood method was faster, cheaper, and appears to be as accurate as direct methods.
PIP: The sisterhood method (Graham et al.) was used to estimate maternal mortality in Bali, Indonesia as a practical, less expensive method with quicker results. Data were based on a prospective community-based survey of reproductive age females in Bali between 1980 and 1982, which was conducted by the National Family Planning Coordinating Board of Indonesia. The sample was a multistage probability proportional sample including 10,005 households and 30,711 persons interviewed. The risk of dying from maternal causes was calculated with adjustments for sisters who had not reached reproductive age and time-location; methods were based on those described by Graham et al. The average number of persons per household was 3.1. There were 9545 aged 15-19 years and 8112 aged 20-24 years, which were adjusted upwards to 10,266 and 8215, respectively. The lifetime risk of maternal death was estimated only with data from the 45-49 year age group. The risk was computed as 1 in 102. The maternal mortality ratio was based on data from respondents aged 15-34 years. The maternal mortality ratio for 1982 was estimated at 331 deaths/100,000 live births, when total fertility is assumed to be 2.9. The maternal mortality rate was computed as 32.8 deaths/100,000 women of reproductive age, based on the 1982 general fertility rate of 99 live births/1000 women aged 15-49 years and a maternal mortality ratio of 331 deaths per 100,000 live births. The maternal mortality ratio increased from 282 in 1978 to 331 in 1982. The increase was attributed to differential use of family planning by healthier women, and decreased live births were higher than decreased deaths. Significant underreporting suggested a more accurate maternal mortality ratio of 718 deaths/100,000 live births. The Age Mortality Survey figure was estimated at 359 compared to the sisterhood estimation of 331; the differences were attributed to a variety of causes, but did not change the conclusion that the sisterhood method was appropriate for use in Indonesia.