title: Progress on the maternal mortality ratio reduction in Wuhan, China in 2001-2012.
abstract: BACKGROUND
  Most maternal deaths occur in developing countries and most maternal deaths are avoidable. China has made a great effort to reduce MMR by three quarters to meet the fifth Millennium Development Goal (MDG5).
  
  
  METHODS
  This retrospective study reviewed and analyzed maternal death data in Wuhan from 2001 to 2012. Joinpoint regression and multivariate Poisson regression was conducted using the log-linear model to measure the association of the number of maternal deaths with time, cause of death, where the death occurred, and cognitive factors including knowledge, attitude, resource, and management stratified.
  
  
  RESULTS
  The MMR declined from 33.41 per 100,000 live births in 2001 to 10.63 per 100,000 live births in 2012, with a total decline of 68.18% and an average annual decline of 9.89%. From 2001-2012, the four major causes of maternal death were obstetric hemorrhage (35.16%), pregnancy complications (28.57%), amniotic fluid embolism (16.48%) and gestational hypertension (8.79%). Multivariate Poisson regression showed on average the MMR decreased by.17% each year from 2001-2006 and stayed stagnant since 2007-2012.
  
  
  CONCLUSIONS
  With the reduction in MMR in obstetric death (e.g. obstetric hemorrhage), there had been a remarkable reduction in MMR in Wuhan in 2001-2012, which may be due to (1) the improvement in the obstetric quality of perinatal care service on prevention and treatment of obstetric hemorrhage and emergency care skills, and (2) the improvement in the maternal health management and quality of prenatal care. Interventions to further reduce the MMR include several efforts such as the following: (1) designing community-based interventions, (2) providing subsidies to rural women and/hospitals for hospital delivery, (3) screening for pregnancy complications, and (4) establishing an emergency rescue system for critically ill pregnant women.
authors.affiliation: Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, China.
authors.forename: Shaoping
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.affiliation: Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, China.
authors.forename: Jinzhu
authors.initials: J
authors.lastname: Zhao
authors.affiliation: College of Public Health and Social Justice, St. Louis University, St. Louis, Missouri, United States of America.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: College of Public Health and Social Justice, St. Louis University, St. Louis, Missouri, United States of America.
authors.forename: Louise
authors.initials: L
authors.lastname: Flick
authors.affiliation: College of Public Health and Social Justice, St. Louis University, St. Louis, Missouri, United States of America.
authors.forename: Zhengmin
authors.initials: Z
authors.lastname: Qian
authors.affiliation: Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, China.
authors.forename: Dan
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Mei
mesh_terms: D002681:China / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016014:Linear Models; D050498:Live Birth; D008428:Maternal Mortality; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000401:mortality*; D016012:Poisson Distribution; D011247:Pregnancy; D058996:Quality Improvement; D012424:Rural Population