title: Maternal mortality in Yunnan, China: recent trends and associated factors.
abstract: OBJECTIVE
  Yunnan Province, located in southwest China, is one of the poorest province in China. The maternal mortality ratio (MMR) is about twice the national average (56.2/100,000 live births), and in remote mountainous regions, the rate is five times higher. This study aimed to examine the progress in reduction of maternal mortality in the 1990s and early 2000s and the factors associated with this reduction in Yunnan.
  
  
  METHODS
  A population-based, longitudinal, ecological correlation study.
  
  
  METHODS
  A remote province of China with a proportionately large indigenous population.
  
  
  METHODS
  Populations at county, prefecture and provincial level.
  
  
  METHODS
  Using maternal mortality data collected at the province, prefecture/region and county levels, trend and time series analyses and multivariate linear regression analyses were performed using SPSS (Version 13).
  
  
  METHODS
  MMR and its change over time.
  
  
  RESULTS
  MMR declined substantially in the 1990s at a rate of 3.0% per year. Utilisation of prenatal and obstetric care increased and was significantly correlated with the declining trend in MMR. Hospital delivery was a strong predictor of MMR, independent of social and economic development. Both low income and illiteracy were significantly associated with increased MMR.
  
  
  CONCLUSIONS
  Declines in maternal mortality in Yunnan over the past 14 years appear to reflect health, social and economic interventions implemented in the 1990s. The association of hospital delivery with maternal mortality may be due to the effective management of severe pregnancy and birth complications. Low income and illiteracy were associated with MMR but primarily through their impact on the use of prenatal and obstetric care.
authors.affiliation: Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Subiaco, Western Australia, Australia. jianghongl@ichr.uwa.edu.au
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: C
authors.initials: C
authors.lastname: Luo
authors.forename: R
authors.initials: R
authors.lastname: Deng
authors.forename: P
authors.initials: P
authors.lastname: Jacoby
authors.forename: N
authors.initials: N
authors.lastname: de Klerk
mesh_terms: D002681:China / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008428:Maternal Mortality / Q000639:trends; D015999:Multivariate Analysis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics