Twenty-three percent of deaths to women of reproductive age (15-49 years) in Bali, Indonesia and Menoufia, Egypt were due to maternal causes. Among the younger women, the percentage was even higher. In both areas complications of pregnancy and childbirth were a leading cause of death (the first cause in Bali, the second in Menoufia). In both sites, postpartum hemorrhage was the most common cause of maternal death. Relative to the United States, the number of maternal deaths per 100,000 live births was 20 times higher in Menoufia and 78 times higher in Bali. Families of women of reproductive age who died were interviewed about the conditions leading to death and other characteristics of the deceased. Completed histories were reviewed by a Medical Panel who were able to assign a cause of death in more than 90% of cases. Two-thirds of the maternal deaths occurred to women who were over 30 and/or who had 3 children--the usual targets of family planning programs. Other possible intervention strategies include antenatal outreach programs, training of traditional birth attendants, and better hospital management of obstetric emergencies.

Data on cause of death are deficient for most developing countries. Nevertheless, it is important for policy makers to have access to such information to plan the use of resources and to evaluate health programs. In this study, deaths among women of reproductive age (15 to 49) in two areas in developing countries were located, and family members were interviewed. Local physicians reviewed the completed interviews and determined the cause of death.Complications of pregnancy and childbirth were the cause of 23% of the deaths in Menoufia, Egypt and Bali, Indonesia. In Egypt, the first cause of death was circulatory system disease (28%), followed by complications of pregnancy and childbirth (23%), and trauma (14%, primarily burns). In Indonesia, complications of pregnancy and childbirth was the first cause of death, followed by infectious disease (22%, primarily tuberculosis), and circulatory system disease (13%).Although the method of data collection was unorthodox, findings for Menoufia are comparable to data from other sources for the country as a whole. There are few data with which to compare our findings for Bali, but their similarity to the data from the Egyptian study lends credence to their quality.

Couples in rural areas of many Arab societies, including Egypt, have consistently reported strong preferences for having sons. However, these reported preferences are not always reflected in reproductive behavior. In 38 rural villages in Menoufia Governorate in Egypt, women's responses to a community-based contraceptive distribution program were examined, taking into consideration both the number of living children and the number of living sons each women reported having. Controlling for number of living children, women with more sons were more likely to be using contraception before the distribution program began. Among women not using contraception before the program, those with more sons were more likely to initiate contraceptive use and were more likely to continue use for a nine-month period following the distribution. These findings imply that in addition to obstacles related to contraceptive availability, there are several cultural, social, and economic factors that influence fertility behavior and exert considerable pressure on married couples to have large families, including several sons. Unless the pressure exerted by these factors is changed or reduced, the impact of family planning programs is likely to reach a plateau at a relatively low prevalence level.

Summary. A survey of all registered deaths which occurred during 1981–1983 in women of reproductive age was carried out in Menoufia Governorate, Egypt. Surviving family members were interviewed by trained social workers, and Information was collected on Symptoms of the disease that led to death. The completed questionnaires were reviewed by a panel of local physicians and a cause of death was assigned by the panel. Maternal mortality was a leading cause of death, second only to heart disease. There were 190 maternal deaths per 100 000 livebirths and 45 maternal deaths per 100 000 married women aged between 15 and 49 years. Most of the maternal deaths (63%) were due to direct obstetric causes of which haemorrhage was the main cause. Another 27% of the maternal deaths were due to indirect obstetric causes of which rheumatic heart disease was the main cause.

Reproductive mortality includes mortality attributable to pregnancy, termination of pregnancy, childbirth and its sequelae, and contraception. Reproductive mortality has been estimated for the United Kingdom, the United States, and for states of the US. However, it has not previously been measured for developing countries, where maternal mortality often remains distressingly high. This paper reports on data from one govemorate of Egypt, where reproductive mortality was 46 per 100,000 married women ages 15-49 Address reprint requests to Judith A