Understanding regional differences in maternal mortality: a national case–control study in France

Abstract

Objectives To assess the risk of postpartum maternal death associated with region, and to examine whether the quality of care received by the women who died differed by region.Design A national case-control study. Methods Crude and adjusted odds ratios (aOR) of maternal death associated with region were calculated with logistic regression, and the quality of care for women who died was compared according to region with chi-square tests or Fisher's exact tests.Main outcome measures Risk of postpartum maternal death associated with region, and quality of care.Results After adjustment for maternal age and nationality, the risk of maternal death was higher in the Ile-de-France region (aOR 1.6, 95% CI 1.2-2.0) and the overseas districts (aOR 3.5, 95% CI 2.4-5.0) than in the group for the rest of continental France. In both regions, the excess risk of death from haemorrhage, amniotic fluid embolism and hypertensive disorders was significant. In continental France, after further controlling for women's obstetric characteristics, the risk of maternal death in Ile-de-France remained higher (aOR 1.8. 95% CI 1.3-2.6). The women in the cases groups received suboptimal care more frequently in Ile-de-France than in the other continental regions (64% versus 43%, P = 0.01).Conclusions These results suggest that quality of care and organisation of health services may play a role in the differential risk of maternal mortality between regions in France. Research on severe maternal morbidity and its determinants is needed to clarify the mechanisms involved.

Maternal Mortality Among Immigrant Women in Europe and the USA: a Systematic Review

“…By investigating the literature, we can see that the increase in the risk of maternal death is not equally distributed among the different groups of immigrants. Furthermore, marked differences can be observed among different regions of the same country, for example in France where maternal mortality is higher in non-native women, particularly in Paris, due to poorer prenatal care [7].…”

Occupation and maternal mortality in Brazil

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Suboptimal care and maternal mortality among foreign-born women in Sweden: maternal death audit with application of the ‘migration three delays’ model

“…However, in HIC maternal mortality is rare, and it can take years to approach a clear understanding about risks and how to improve health care conditions in a single, particular setting [7,15]. Scrutinising the road to death may therefore clarify why the incidence is higher for different groups of women [4,16,17] and why women representing high risk groups face barriers to care-seeking or regular utilisation of available maternity care services [8,18,19]. Assessing both the quality of maternity care that a woman received and her own pregnancy care strategies may be essential [20].…”