Estimating the impact of interventions on cause-specific maternal mortality: a Delphi approach

BACKGROUND: Approximately 287,000 women die of causes related to pregnancy and childbirth every year. While effective interventions exist to prevent maternal death, high quality impact evaluations for these interventions are often lacking. METHODS: We conducted a Delphi process consisting of three rounds in which we asked maternal health experts to provide effectiveness estimates for 31 intervention-cause of death pairs relating to maternal mortality. Anonymous feedback in the form of medians and histograms for each question was given to experts following the first and second rounds. A diverse panel of 37 experts completed all three rounds, for a final response rate 80.4%. RESULTS: This Delphi process produced a total of 31 effectiveness estimates for key maternal interventions on cause-specific maternal mortality. Overall, many interventions had high estimated effectiveness, with the majority of interventions having effectiveness estimates above 70%. Where possible, the estimates of effectiveness of interventions were compared to previous efforts and in general there was strong agreement between the estimates in this exercise as compared to those of earlier efforts. CONCLUSIONS: There are many maternal health interventions with high estimated effectiveness that, with expansion of effective delivery channels, have the potential to have a large impact on reducing maternal mortality worldwide.