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The sisterhood method for estimating the level of maternal mortality. Seven years' experience.


 The sisterhood method for estimating the level of maternal mortality was developed at the London School of Hygiene and Tropical Medicine. This indirect method of estimation collects data by means of four questions about the death of adult sisters: 1) How many sisters have your ever had (born to the same mother) who ever reached age 15 years? 2) How many of these adult sisters are alive now? 3) How many of these adult sisters are dead? and 4) How many of these dead sisters died during pregnancy, childbirth, or during the six weeks after the end of pregnancy? Information is needed on the five-year age group of the respondent. These questions can be inserted in any survey instrument among all adults in the survey sample. Direct interviews are recommended. Multiple reporting among siblings is not considered to be a problem. The first test of the method was in The Gambia in 1987. Results estimated maternal mortality as 1005 per 100,000 live births. This figure is comparable to figures of 1050 and 950 from other sources. The World Health Organization Factbook on Maternal Mortality cites the sisterhood method as the source for its published estimates. The internal consistency of the data is dependent on the quality of fieldwork and reinterviews of a subsample of respondents concurrently with the survey administration. The sisterhood method is beneficial in the ease of adding four more questions to an existing survey instrument, the small sample size requirements (5500 two-person households), the simplicity of calculations, the opportunity for more detailed community follow-up, and the option of using an opportunistic sample. A community-based sample is best, but the method was successfully used in Nicaragua among a population attending government health facilities. Disadvantages are retrospective data, contamination of results if out-migration is high, and potential inappropriateness of the average age specific fertility profile in areas with either very high or low fertility.
