to "unkncwn" causes-Royston & lopez, 1987), or they may not identify the pregnancy and thus mislabel the materna.l death as being due to sane other "'adult" cause, many deaths simply go uncounted, and some have mislabeled maternal causes*. In countries where abortions are illegal, for example, deaths due to abortion may be masked as deaths due to hemrrhage or sepsis or even omo.-maternal causes. The maternal mortality ratio uses live births for the dencminator as an estimate of number of pregnancies. Where unreported abortions are high this estimate deviates from reality and underestimates conception; the maternal mortality ratio may appear artificially h_qh. Royston and Lopez (1987) discuss methods of getting estimates for maternal mortality where official registration of deaths is inconplete or inaaxurate (even in the United States registration data are believed to underreport deaths by about 25%). These include hospital estimates, cause of death inquiries, and household inquiries (the latter are less valid for counting deaths; they are better for elucidating social, logistic and meiical causes of death).

The maternal mortality ratio in Jamaica, derived fran cause of death inquiries between 1981 to 1983, was 108 deaths per 100,000 live births (Walker et al., 1986); this figure includes deaths fran abortions and .is nearly three times the rate obtained fran national registration data (48/100,000). The Walker report was the result of a re-established Maternal Mortality Ccmmittee in the Ministry of Health and the results sparked further interest in maternal health in Jamaica. The maternal mortality ratio for Jamaica of 108/100,000 live births does not use the ICD-9 classification, rather it includes deaths up to one year past delivery or termination if they are related to the pr-ngnancy. The same study came up with a ratio of 102/100,000 using the ICD-9 definition.

_The_ most common causes of maternal death in Jamaica are hypertensive diseases of pregnancy (26%), hemorrhage (20%), ectopic pregnancy (10%), pulmonary embolism (8%), and sepsis (8f) (Walker et al., 1986). These are overwhelmingly preventable causes. Death is also closely related to age and parity; the lowest rates are for women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years.

Maternal mortality is difficult to study as it is a relatively rare event; morbidity, alternatively, has not yet received the same international attention as mortality has. Only one study has ever measured the ratio of maternal morbidities to deaths; this study, based in nrual India, found there were 16 morbid events for every death (Datta et al., 1973). Alternative outoo measures that one can investigate for maternal health are: lost productivity due to pregnancy cmplications or childbirth, the degree to which wamen reassign their responsibilities during illness, incidence of low birth weight, and perinatal mortality or morbidity. The thorough study of perinatal health by the Ministry of Health in Jamaica provides valuable insights to problem and conditions affecting the health of the mothers as well. We can also learn more about maternal health by studying women's health in general.

The health problems of _waoen_ in Jamaica were discaussed at the First International Congress on Women's Health Issues in 1984 (Segree, 1985). In ways that are similar to women in other developing countries, Jamaican women are interesting for study because 1) the wamen's p ysiology and lives are closely related to their reptoductive functions, 2) -,oien's health is reflected in the health of their children and families, and 3) women are 3