Even in developed countries where routine registration of deaths is in place, maternal deaths may be underreported, due to misclassification of ICD-10 coding, and identification of the true numbers of maternal deaths may require additional special investigations into the causes of death (Appendix 1). A specific example of such an investigation is the Confidential Enquiry into Maternal Deaths (CEMD), a system established in England and Wales in 1928 (11). The most recent report of the CEMD (for 2006–2008) identified 60% more maternal deaths than were reported in the routine civil registration system (12). Other studies on the accuracy of the number of maternal deaths reported in civil.
