1Assiatant Professor, Department of Environmental Health and Medical Entomology, School of Health, Kerman University of Medical Sciences, Kerman, Iran
2Gynecologist, Department of Obstetrics and Gynecology, School of Medicine, Shahed University of Medical Sciences, Tehran, Iran
3Gynecologist, Department of Maternal Health Care, Ministry of Health and Medical Education, Tehran, Iran
4Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
5Department of Maternal Health Care, Ministry of Health and Medical Education, Tehran, Iran
6Associate Professor, Department of Biostatistics and Epidemiology, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
7Professor, Department of Biostatistics and Epidemiology, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
Background & Aims: Maternal mortality is a tragedy which threatens human life. It is an indicator of womenʼs health and development of society as well. Therefore, prevention of maternal deaths is one of the main goals in many countries, including Iran. The aim of this study was to review and analyze the recorded data on maternal mortality in the country, in order to improve the management of maternal mortality. Methods: In this ecological study, the data related to the maternal mortality during the years 2007-2010 were obtained from the Health unit at the Iranian Ministry of Health and Medical Education. Data were analyzed according to the number of births during the studied period and the country indices using univariate and multivariate analysis methodologies. Results: The maternal mortality ratio (MMR) in the studied years was calculated by 22.3 per 100,000 of live births which showed the average reduction of 0.41 in every 100,000 births annually in the whole country. The highest value was reported in Sistan and Baluchistan province (48.6) and the lowest in Cheharmehal and Bakhtyari province (9.6). In Iran, the maternal mortality was relatively high in the age groups under the 15 (50.2 in every 100,000 child births) and over the 35 years (61.3 in every 100000 child births). The analysis related to the different provinces indicated that there was a significant reverse relationship between the maternal mortality ratio and variables of net attendance of girls in secondary schools, men and women literacy, access to improved water and sanitation, as well as antenatal and delivery care. Likewise, there was a significant positive relationship between the maternal mortality ratio and births in the house assisted by unskilled health personnel. Conclusion: This study showed the association between the health and social variables with maternal mortality ratio in Iran at an ecologic level. In order to reduce maternal mortality, more efforts seem to be essential to develop the various provinces, particularly poor areas.
World Health Organization, UNICEF, UNFPA, The World Bank estimates. Trends in maternal mortality: 1990 to 2010 [Online]. [cited 2012]; Available from: URL: http://www.who.int/reproductivehealth/publications/monitoring/9789241503631/en/
World Health Organization. Maternal and reproductive health [Online]. [cited 2013]; URL: http://www.who.int/gho/maternal_health/en/
Wilmoth JR, Mizoguchi N, Oestergaard MZ, Say L, Mathers CD, Zureick-Brown S, et al. A New Method for deriving global estimates of maternal mortality. Statistics, Politics, and Policy: 2012; 3(2): 1-41.
Donnay F. Maternal survival in developing countries: what has been done, what can be achieved in the next decade. Int J Gynaecol Obstet 2000; 70(1): 89-97.
Azemikhah A, Amirkhani MA, Jalilvand P, Emami Afshar N, Radpooyan L, Changizi N. National Maternal Mortality Surveillance System in Iran. Iranian J Public Health 2009; 38(Suppl 1): 90-2.
World Health Organization. Maternal mortality country profiles [Online]. [cited 2013 Jul]; Available from: URL: http://www.who.int/gho/maternal_health/countries/en/
Abdolahpour P, Babaei M, Gasemi YM. Causes of maternal mortality in pregnant women in urban and rural areas of Ilam, Iran. J Health Syst Res 2011; 7(6): 1278-87. [In Persian].
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med 1994; 38(8): 1091-110.
Karlsen S, Say L, Souza JP, Hogue CJ, Calles DL, Gulmezoglu AM, et al. The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health. BMC Public Health 2011; 11: 606.
McAlister C, Baskett TF. Female education and maternal mortality: a worldwide survey. J Obstet Gynaecol Can 2006; 28(11): 983-90.
Zolala F, Heidari F, Afshar N, Haghdoost AA. Exploring maternal mortality in relation to socioeconomic factors in Iran. Singapore Med J 2012; 53(10): 684-9.
Koch E, Thorp J, Bravo M, Gatica S, Romero C, Aguilera H, et al. Women's education level, maternal health facilities, abortion legislation and maternal deaths: a natural experiment in chile from 1957 to 2007. PLoS ONE 2012; 7(5): e36613.
Benova L, Cumming O, Campbell OM. Systematic review and meta-analysis: association between water and sanitation environment and maternal mortality. Trop Med Int Health 2014; 19(4): 368-87.
Moazzeni MS. Maternal mortality in the Islamic Republic of Iran: on track and in transition. Matern Child Health J 2013; 17(4): 577-80.
Zolala F, Haghdoost AA. A Gap between policy and practice: a case study on maternal mortality reports, Kerman, Iran. Int J Prev Med 2011; 2(2): 88-93.
Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. The Lancet 2010; 375(9726): 1609-23.
Mohamadinia N, Samiezadeh Toosi T, Rezaie MA, Rostaie F. Investigating the frequency and effective factors on maternal mortality in Sistan and Baluchistan province, Iran, 2002-2009. Iran J Obstet Gynecol Infertil 2013; 16(44): 28-34. [In Persian].
Rashidian A, Khosravi A, Arab M, Behashtian M, Khabiri R, Karimi A, et al. Health observatory: First report I.R. Iran multiple-indicatory demographic and health survey. Tehran, Iran: National Institute for Health Research; 2010. [In Persian].
Malekafzali H, Holakouie Naieni K, Rashidian A, Vazirian P, Moradi G, Mirzazadeh A, et al. Tracking the maternal mortality in economic cooperation countries; achievement and gaps toward millennium development goals. J Fam Reprod Health 2010; 4(1): 9-14.
Khosravi A, Taylor R, Naghavi M, Lopez AD. Differential mortality in Iran. Population Health Metrics 2007; 5: 7.
Abbasi-Shavazi MJ, McDonald P. national and provincial-level fertility trends in Iran, 1972–2000. Working Papers in Demography 2005; 94: 1-42.
Nove A, Matthews Z, Neal S, Camacho AV. Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries. The Lancet Global Health 2014; 2(3): e155-e164.
Blanc AK, Winfrey W, Ross J. New findings for maternal mortality age patterns: aggregated results for 38 countries. PLoS ONE 2013; 8(4): e59864.
Restrepo-Méndez MC, Victora CG. Maternal mortality by age: who is most at risk? The Lancet Global Health 2014; 2(3): e120-e121.
Farrokh Eslamloo HR, Nanbakhsh F, Heshmati F, Amirabi A. An epidemiological research of maternal mortality in East Azerbaijan 2001-2005. Urmia Med J 2005; 17(1): 23-31. [In Persian].
Tajik P, Nedjat S, Emami Afshar N, Changizi N, Yazdizadeh B, Azemikhah A, et al. Inequality in Maternal Mortality in Iran: An Ecologic Study. Int J Prev Med 2012; 3(2): 116-21.
Rahman M, DaVanzo J, Razzaque A, Ahmed K, Hale L. Demographic, programmatic, and socioeconomic correlates of maternal mortality in Matlab, Bangladesh. Detroit, Michigan: Population Association of America; 2009.
UNICEF. Progress for children A Report Card on Maternal Mortality [Online]. [cited 2008 Sep]; Available from: URL: http://www.unicef.org/progressforchildren/files/Progress_for_Children-No._7_Lo-Res_082008.pdf
Sanaie Nasab H, Rashidi Jahan H, Tvakoli R, Tavakoli HR, Amin Shokravi F. Unwanted pregnancy and its risk factors in women referred to health centers. J of Nurse and Midwifery, Tehran Uni Med Sci 2009; 15(2): 86-1 [In Persian].
UNFPA. Rich mother, poor mother: the social determinants of maternal death and disability [Online]. [cited 2012 Dec]; Available from: http://www.unfpa.org/sites/default/files/resource-pdf/EN-SRH%20fact%20sheet-Poormother.pdf
Dagne E. Role of socio-demographic factors on utilization of maternal health care services in Ethiopia. Umeå, Sweden: Umeå University; 2010.
Hertz E, Hebert JR, Landon J. Social and environmental factors and life expectancy, infant mortality, and maternal mortality rates: results of a cross-national comparison. Soc Sci Med 1994; 39(1): 105-14.
Cheng JJ, Schuster-Wallace CJ, Watt S, Newbold BK, Mente A. An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality. Environ Health 2012; 11: 4.
Alvarez JL, Gil R, Hernández V, Gil A. Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study. BMC Public Health 2009; 9: 462.
Walraven G, Telfer M, Rowley J, Ronsmans C. Maternal mortality in rural Gambia: levels, causes and contributing factors. Bull World Health Organ 2000; 78(5): 603-13.