title: Economic impact of maternal death on households in rural china: a prospective cohort study.
abstract: OBJECTIVE
  To assess the economic impact of maternal death on rural Chinese households during the year after maternal death.
  
  
  METHODS
  A prospective cohort study matched 183 households who had suffered a maternal death to 346 households that experienced childbirth without maternal death in rural areas of three provinces in China. Surveys were conducted at baseline (1-3 months after maternal death or childbirth) and one year after baseline using the quantitative questionnaire. We investigated household income, expenditure, accumulated debts, and self-reported household economic status. Difference-in-Difference (DID), linear regression, and logistic regression analyses were used to compare the economic status between households with and without maternal death.
  
  
  RESULTS
  The households with maternal death had a higher risk of self-reported "household economy became worse" during the follow-up period (adjusted OR = 6.04, p<0.001). During the follow-up period, at the household level, DID estimator of income and expenditure showed that households with maternal death had a significant relative reduction of US$ 869 and US$ 650, compared to those households that experienced childbirth with no adverse event (p<0.001). Converted to proportions of change, an average of 32.0% reduction of annual income and 24.9% reduction of annual expenditure were observed in households with a maternal death. The mean increase of accumulated debts in households with a maternal death was 3.2 times as high as that in households without maternal death (p = 0.024). Expenditure pattern of households with maternal death changed, with lower consumption on food (p = 0.037), clothes and commodity (p = 0.003), traffic and communication (p = 0.022) and higher consumption on cigarette or alcohol (p = 0.014).
  
  
  CONCLUSIONS
  Compared with childbirth, maternal death had adverse impact on household economy, including higher risk of self-reported "household economy became worse", decreased income and expenditure, increased debts and changed expenditure pattern.
authors.affiliation: Division of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
authors.forename: Haijun
authors.initials: H
authors.lastname: Wang
authors.forename: Fang
authors.initials: F
authors.lastname: Ye
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Dale
authors.initials: D
authors.lastname: Huntington
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D005191:Family Characteristics; D006801:Humans; D007182:Income; D063130:Maternal Death / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D057566:Self Report; D012959:Socioeconomic Factors; D055815:Young Adult