Metrics: What Counts in Global Health
Getting Good Numbers
This chapter examines the explanatory functions and lapses of the maternal mortality ratio, the most commonly used maternal health indicator. Unlike people, metrics can be tracked, graphed, compared across time and space, converted to dollars, inserted into equations, and statistically manipulated. They are politically useful, yet their political weight rests upon their claim to represent (in aggregate) actual people. The chapter juxtaposes evidence from research on maternal death in southeastern Africa with an analysis of the assumptions built into statistical models of maternal mortality. It shows how equations, like other ways of describing maternal death, are partial—and consequential—explanatory narratives.
This chapter explores the relationships between political practices and evidence making in maternal health in Nigeria’s efforts to meet the Millennium Development Goals. Many actors become invested in the exercises of counting maternal outcomes and making decisions about care that will impact these outcomes, and all of these are woven into the exercise of politics in this region. Contestation over the real meaning of “getting the numbers” thus becomes commonplace but also focused less on medical than political goals.