Although there is no doubt that maternal mortality is reducing, questions continue to be raised about the exact figure for MMR, for example the Bureau of Health Promotion retrospective study of maternal mortality during 1995-1996 using RAMOS approach (Reproductive Age Mortality Survey) revealed a much higher figure than national figures obtained from routine data. Estimates using the RAMOS approach suggest the maternal mortality ratio in 1991 was per 100,000 live births and 43 per 100,000 live births in 1996. Recently however the health data systems have been strengthened and it is expected that future data will be more reliable. Approximately of all births in Thailand take place in a hospital or institution,.
