title: Reduced maternal mortality in Tunisia and voluntary commitment to gender-related concerns.
abstract: OBJECTIVE
  To estimate the number and causes of maternal deaths in Tunisia from 1999 to 2007, and compare the results with the last report (1993-1994).
  
  
  METHODS
  Data on all deaths of women of reproductive age in the public (1999-2007) and private (2006 only) health sectors were collected and assessed for whether the death was due to pregnancy. Number of live births was provided by the National Institute of Statistics.
  
  
  RESULTS
  Mean maternal mortality ratio (MMR) in Tunisia decreased from 68.9 per 100000 live births in 1993-1994 to 36.3 (95% confidence interval, 27.9-46.5) in 2005-2007 (P<0.001). Causes of maternal death did not change significantly during the study period (1999-2007): hemorrhage and hypertensive disorders were the main causes. The gap between urbanized and more rural regions observed in 1993-1994 had narrowed, although MMR remained higher in central and western regions than on the east coast.
  
  
  CONCLUSIONS
  The improvement in MMR can be credited to the voluntary political commitment focused on gender-related concerns that has been made in Tunisia, including access to family planning; legalization of abortion; and creation of the National Board for Family and Population, and the Tunisian Safe Motherhood initiative in 1999.
authors.affiliation: Primary Health Care Directorate, Ministry of Public Health of Tunisia, Tunis, Tunisia.
authors.forename: Essia Ben
authors.initials: EB
authors.lastname: Farhat
authors.forename: Mohamed
authors.initials: M
authors.lastname: Chaouch
authors.forename: Hela
authors.initials: H
authors.lastname: Chelli
authors.forename: Mohamed F
authors.initials: MF
authors.lastname: Gara
authors.forename: Noureddine
authors.initials: N
authors.lastname: Boukraa
authors.forename: Mounira
authors.initials: M
authors.lastname: Garbouj
authors.forename: Mongi
authors.initials: M
authors.lastname: Hamrouni
authors.forename: Akthem
authors.initials: A
authors.lastname: Fourati
authors.forename: Thierry
authors.initials: T
authors.lastname: Calvez
authors.forename: Patrick
authors.initials: P
authors.lastname: Thonneau
mesh_terms: D000029:Abortion, Legal; D000293:Adolescent; D000328:Adult; D005193:Family Planning Services / Q000639:trends; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008427:Maternal Health Services / Q000592:standards* / Q000639:trends; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D014416:Tunisia / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult