Percent of audience that know three primary warning/danger signs of obstetric complications

Community knowledge and awareness of the warning/ danger signs of obstetric complications

"Audience" is the intended population for the program (e.g., pregnant women, husbands or other members of the community who influence decisions about care seeking at the time of delivery).

"Know" refers to the percentage who can spontaneously name at least three primary warning signs of specific obstetric complications, which in a wide range of settings include:

  • Severe persistent abdominal pain;
  • Vaginal bleeding during pregnancy;
  • Severe vaginal bleeding after delivery;
  • Labor >12 hours (obstructed labor);
  • Placenta retained > 1 hour;
  • Convulsions or fits;
  • Loss of consciousness;
  • High grade fever;
  • Marked fetal movement;
  • Swelling of face, fingers and feet (pre-eclampsia/eclampsia); and
  • Problems urinating (i.e. painful urination, insufficient urination).

 This indicator is calculated as:

(Number of target audience who know at least three warning/danger signs of obstetric complications / total number in the intended audience) x 100


Number of people in the target audience who can name at least three of the warning signs of obstetric complications (listed above); total population defined as the intended audience


Population-based surveys


The purpose of this indicator is to assess community knowledge and awareness of the warning/danger signs of obstetric complications in order to plan and monitor the impact of safe motherhood initiatives at the community level.

Knowledge of the danger signs of obstetric complications is the essential first step in avoiding the first delay-- seeking appropriate and timely referral to essential obstetric and newborn care services (Perreira et al., 2001).

Improvement in knowledge of obstetric complications is usually much smaller than improvements in other health-education messages such as self care (MotherCare, 2000a and 2000b).


Knowledge of the danger signs of an obstetric complication is only one aspect of obstetric-problem recognition at the community level. Knowledge about the severity of an obstetric complication (i.e., knowing when to take action) and knowledge about the appropriate lifesaving action for each complication are also important. Moreover, adequate knowledge does not guarantee that an individual will recognize a complication in practice. Certain obstetric complications that evolve from a normal to an emergency state (e.g., postpartum hemorrhage) may be particularly difficult to recognize. Care seeking is also strongly influenced by cultural beliefs about the etiology of an illness. These beliefs may more powerfully influence an individual's action than will his/her recent knowledge of the appropriate action to take (MotherCare, 2000a and 2000b).

Evaluators should combine knowledge of pregnancy danger signs with other indicators measuring related aspects of knowledge and behavior to assess the real impact of any awareness-raising program. Complementary indicators can include, for example, the percentage of the population who know the location of emergency obstetric services and the percentage of the population who intend to use these services in the event of emergency.

Indicators of knowledge of danger signs and related indicators should be complemented by good quality formative research and, where appropriate, qualitative methodologies such as illness narratives (MotherCare, 2000a and 2000b).


postabortion care, knowledge, obstetric fistula (OF), communication, safe motherhood (SM), access

Most maternal deaths are due to sudden and unexpected complications. To reduce the nearly 600,000 deaths occurring each year from largely preventable causes, much effort has focused on training health workers and pregnant women to recognize danger signs so that serious complications are recognized soon enough to receive medical attention. Few efforts have been made to educate men about the risks of pregnancy, even though men often control decisions to seek medical attention and often arrange and pay for transport to a health facility. If men as well as women understood that all pregnancies carry some risk, complications would be recognized and treated.

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