Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996.
BACKGROUND
Maternal mortality is a sensitive indicator for inequity in health. We describe recent trends in overall and cause-specific maternal mortality ratio among women of German and non-German nationality residing in West Germany.


METHODS
Using birth and death register data for 1980-1996 we related 1067 cases of maternal death (ICD 9: 630-676) to 11.2 million live births. We assessed the effects of nationality and of marital status, a proxy for socioeconomic status, controlling for year of death and age of the mother in a Poisson regression model.


RESULTS
Maternal mortality ratio in West Germany decreased from 13 per 100000 live births in 1980-1988 to 6.1 in 1989-1996. The crude relative risk for non-German nationality decreased from 1.9 (95% CI: 1.6-2.3) to 1.3 (1.0-1.7); after adjusting for age, year of death and marital status it was 1.7 (95% CI: 1.4-2.1) and 1.6 (95% CI: 1.2-2.1). Unmarried women incurred an adjusted relative risk of 1.8 (95% CI: 1.5-2.3). Non-German women experienced an excess mortality from abortions which largely disappeared in 1989-1996; concurrently, being unmarried no longer conveyed an additional risk to them. The risk status of German mothers developed unfavourably: increasing proportions are unmarried, which continues to be a marker of elevated relative risk in this group.


CONCLUSIONS
Our findings suggest continuously improving accessibility and quality of obstetric services, in particular for women of non-German nationality. Still, inequity in maternal risk continues to exist. Maternal risk, however, is not determined by the simple distinction 'German' versus 'non-German'; its association with socioeconomic status extends beyond nationality.
Razum
O
O
Department of Tropical Hygiene and Public Health, Heidelberg, Germany. oliver.razum@urz.uni-heidelberg.de
Jahn
A
A
Blettner
M
M
Reitmaier
P
P
D000028:Abortion, Induced / Q000706:statistics & numerical data; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D016001:Confidence Intervals; D003431:Cross-Cultural Comparison; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D005860:Germany, West / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D016012:Poisson Distribution; D011247:Pregnancy; D012042:Registries; D012307:Risk Factors; D016387:Women's Health