Maternal mortality ratio in China from 1990 to 2019: trends, causes and correlations

Abstract

Background Maternal mortality ratio is an important indicator to evaluate the health status in developing countries. Previous studies on maternal mortality ratio in China were limited to certain areas or short periods of time, and there was a lack of research on correlations with public health funding. This study aimed to assess the trends in the maternal mortality ratio, the causes of maternal death, and the correlations between maternal mortality ratio and total health financing composition in China from 1990 to 2019. Methods Data in this longitudinal study were collected from the China Health Statistics Yearbooks (1991–2020) and China Statistical Yearbook 2020. Linear regression analysis was used to assess the trends in the maternal mortality ratio in China. Pearson correlation analysis was used to assess the correlations between national maternal mortality ratio and total health financing composition. Results The yearly trends of the national, rural and urban maternal mortality ratio were − 2.290 (p < 0.01), − 3.167 (p < 0.01), and − 0.901 (p < 0.01), respectively. The gap in maternal mortality ratio between urban and rural areas has narrowed. Obstetric hemorrhage was the leading cause of maternal death. The mortalities ratios for the main causes of maternal death all decreased in China from 1990 to 2019. The hospital delivery rate in China increased, with almost all pregnant women giving birth in hospitals in 2019. Government health expenditure as a proportion of total health expenditure was negatively correlated with the maternal mortality ratio (r = − 0.667, p < 0.01), and out-of-pocket health expenditure as a proportion of total health expenditure was positively correlated with the maternal mortality ratio (r = 0.516, p < 0.01). Conclusion China has made remarkable progress in improving maternal survival, especially in rural areas. The maternal mortality ratio in China showed a downward trend over time. To further reduce the maternal mortality ratio, China should take effective measures to prevent obstetric hemorrhage, increase the quality of obstetric care, improve the efficiency and fairness of the government health funding, reduce income inequality, and strengthen the medical security system.

Prophylactic antibiotic use during labor and delivery in China: a nationwide, multicenter, hospital-based, cross-sectional study

“…Besides, we cannot evaluate the temporal trends of prophylactic antibiotic use and clinician adherence in obstetrics practice in China based on the CLDS data. Third, although almost all pregnant women in China have been delivered in hospitals in urban or rural areas since 2014 [ 27 ], few deliveries are performed in primary hospitals [ 16 ]. Also, all secondary and tertiary hospitals with fewer than 1000 annual deliveries were excluded from our sampling frame.…”

“…Besides, we cannot evaluate the temporal trends of prophylactic antibiotic use and clinician adherence in obstetrics practice in China based on the CLDS data. Third, although almost all pregnant women in China have been delivered in hospitals in urban or rural areas since 2014 [27], few deliveries are performed in primary hospitals [16]. Also, all secondary and tertiary hospitals with fewer than Table 2 Distribution of characteristics and their associations with adherence to the guidelines on antibiotic prophylaxis for all delivery OR odds ratio, AOR adjusted odds ratio (adjusted for all variables mentioned above), CI confidence interval 1000 annual deliveries were excluded from our sampling frame.…”

Pregnant under quarantine: Women's agency and access to medical care under Wuhan's COVID-19 lockdown

“…Hospitals are perceived by Chinese women as a safe place for childbirth because health care professionals are available if emergencies arise ( Raven et al, 2015 ). Statistics indicate that in 2019, almost all pregnant women gave birth in hospitals ( Chen et al, 2021 ). Therefore, while women in other countries may opt to give birth at home attended by registered midwives to avoid risk of COVID-19 infection in hospitals, Chinese women have no such option.…”

Effect of intraoperative cell rescue on bleeding related indexes after cesarean section

“…It has also been recently reported to be the leading cause of death among pregnant women in China. With the liberalization of China’s birth policy, there are more and more elderly pregnant women, and their risk of postpartum hemorrhage increases accordingly[ 3 ]. The key to a successful rescue is immediate and rapid blood transfusion; however, traditional allogeneic blood transfusion involves safety problems, including blood shortage, transfusion-related infection, and immune suppression[ 4 , 5 ], which poses great safety risks to puerpera and babies.…”