The relationship between maternal education and mortality among women giving birth in health care institutions: Analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health

Abstract

BackgroundApproximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal education and maternal mortality among women giving birth in health care institutions and investigates the association of maternal age, marital status, parity, institutional capacity and state-level investment in health care with these relationships.MethodsCross-sectional information was collected on 287,035 inpatients giving birth in 373 health care institutions in 24 countries in Africa, Asia and Latin America, between 2004-2005 (in Africa and Latin America) and 2007-2008 (in Asia) as part of the WHO Global Survey on Maternal and Perinatal Health. Analyses investigated associations between indicators measured at the individual, institutional and country level and maternal mortality during the intrapartum period: from admission to, until discharge from, the institution where women gave birth. There were 363 maternal deaths.ResultsIn the adjusted models, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Institutional capacity was not associated with maternal mortality in the adjusted model. Those not married or cohabiting had almost twice the risk of death of those who were. There was a significantly higher risk of death among those aged over 35 (compared with those aged between 20 and 25 years), those with higher numbers of previous births and lower levels of state investment in health care. There were also additional effects relating to country of residence which were not explained in the model.ConclusionsLower levels of maternal education were associated with higher maternal mortality even amongst women able to access facilities providing intrapartum care. More attention should be given to the wider social determinants of health when devising strategies to reduce maternal mortality and to achieve the increasingly elusive MDG for maternal mortality.

Vulnerabilidade da criança diante de situações adversas ao seu desenvolvimento: proposta de matriz analítica

“…In order to develop fully, children need physical protection, care and safe environments that can guarantee a healthy development from birth, through childhood until reaching adolescence (11) . Due to the presence of wars, famine, poverty and lack of health resources, many children do not have this protection guaranteed (16)(17) . Physical protection and safety are expressed by prenatal care (18) , type of delivery and gestational age (19)(20)(21) , physiological conditions of the child (22)(23) , health care and prevention of injuries to the child (14) , dietary pattern (14) and exposure to harmful agents or situations (11,14) .…”

Mortalidade materna e desenvolvimento: a transição obstétrica no Brasil

“…Nos países desenvolvidos, a taxa de mortalidade materna pode ser tão baixa quanto 10 óbi-tos maternos por 100.000 nascidos vivos; em comparação, nos países menos desenvolvidos, ela pode ser tão alta como 1.000 mortes maternas ou mais por 100.000 nascidos vivos 2 . Grandes disparidades são também observadas no interior dos países e quando a população é Editorial desagregada por faixas de renda ou educação 2,3,5 . Assim, os países, as regiões dentro dos países e grupos populacionais dentro dos países estão frequentemente em diferentes pontos do caminho para eliminar a mortalidade materna.…”

Knowledge, Attitude and Practice of Contraception among Postpartum Women Attending Kathmandu Medical College Teaching Hospital

“…1 In developing countries, 55 million unintended pregnancies occur every year to women not using contraceptive method; another 25 million occur as a result of incorrect or inconsistent use of contraceptive method and method failure. 2 Failure to plan a pregnancy can adversely affect the health of the family as a whole and the health of mothers and children remain a subject of global concern.…”