Maternal deaths among rural–urban migrants in China: a case–control study
OBJECTIVE To analyze the results of maternal mortality rate (MMR) surveillance in 247 monitoring areas. METHODS Based on the demographic characteristics of different areas, stratum sampling method was used, and 247 monitoring points from 30 provinces, autonomous regions and cities covered about 100 million population were selected in China in 1989-1995. RESULTS In the 7 years of monitoring there were 8,709,220 cases of live births with 5,984 cases of maternal deaths in these monitoring points. The average MMR was 77.4/100,000 with 45.5/100,000 in urban areas and 95.4/100,000 in rural areas. There were significant differences of MMR from area to area from 26.0/100,000 to 308.0/100,000. The causes of maternal deaths in succession were obstetric hemorrhage, pregnancy induced hypertension, heart diseases, amniotic fluid embolism, puerperal infection and hepatic diseases, and these 6 causes constituted 81.6% of the total. According to the audit of mortality cases demanded by WHO, the results showed that there was 73.0% avoidable deaths and 27.0% unavoidable deaths. The main problems were: 49.7% among the medical and health care system, chiefly lack of knowledge and skill of the medical personnels; 44.5% of the pregnant women and their family members lack the basic health knowledge. CONCLUSION To improve the living condition of both mother and children, to increase hospital delivery rate, training medical personnel's skill, to provide better maternal health care, and to strengthen health education are effective measures to decrease MMR.