世界和中国孕产妇死亡变化趋势及终身风险

Trends, levels and lifetime risks of maternal mortality in the world and in China

目的了解全球1980——2015年不同地域孕产妇死亡变化趋势及中国1990——2014年孕产妇死亡率及死因变化趋势,为政府制定对策和干预措施提供依据。方法利用SPSS 15.0软件建立数据库,将世界各国家和地区不同时期、不同地域,次地域与中国的不同年份、不同地区、城乡的孕产妇死亡率、死因别死亡率等进行统计分析;将中国31个省市区不同年代孕产妇死亡率作系统聚类分析。结果 (1)世界各国和地区1980——2015年35年间孕产妇死亡率下降了52.0%,未达到降低四分之三的千年发展目标要求;南亚、东亚/太平洋、中/东欧下降幅度较大,在70%以上,意味着实现了千年发展目标;80%以上的孕产妇死亡集中发生于西/中非(28.2%)、最不发达国家(18.0%)、东/南非(17.2%)和撒哈拉以南非洲(17.2%);2015年在非洲及最不发达国家妇女妊娠和分娩死亡的终身风险比率在1:52及以下,而发达国家中该比例为1:2 000。(2)中国孕产妇死亡率从1990年的94.7/10万下降为2014年的21.7/10万,降低77.1%,实现了千年发展目标。1990——2014年降低幅度农村(80.7%)大于城市(58.9%),2013年城市和农村孕产妇死亡率分别为22.4/10万和23.6/10万,城乡之间孕产妇死亡率差距逐渐缩小。结论城乡、区域和不同群体之间孕产妇保健状况仍存在差距,农村孕产妇死亡率仍高于城市,西部地区高于东部,流动人口高于常住人口,改善西部地区、农村地区以及流动人口中的妇女健康状况成为妇幼卫生工作的重点和难点。

Objective To examine levels and changing trend of maternal mortality in different regions of the world from 1980 to 2015 and in China from 1990 to 2014 and to provide evidences for developing intervention strategies by governmental agencies.Methods We collected data on maternal mortality and cause-specific mortality in different geographical regions, sub-regions and countries of the world, as well as in different provinces and cities of China, in different years from publications of World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF), and United Nations Fund for Population Activities (UNFPA) and then established a dataset for the data using SPSS 15.0. We conducted hierarchical clustering analysis on the data of 31 provinces, autonomous regions, and municipalities of China during different periods.Results The maternal mortality rate dropped by 52.0% over the 35-year period in all countries and regions in the world and the decline was less than the three-quarters reduction of the Millennium Development Goals. In South Asia, East Asia/Pacific and Central/Eastern Europe, the maternal mortality rate dropped significantly by 70% or above, meaning that the Millennium Development Goals have been achieved. Of all the maternal deaths during 2015 in the world, more than 80% occurred in Western/Central African countries (28.2%), the least developed countries (18.0%), East/South Africa (17.2%), and sub-Saharan Africa (17.2%). In 2015, the lifetime risk ratio of death for women in pregnancy and childbirth was below 1:52 in Africa and the least developed countries but the ratio was 1:2000 in developed countries. In China, the maternal mortality rate dropped from 94.7/100 000 in 1990 to 21.7/100 000 in 2014, with a decline of 77.1% reaching the Millennium Development Goals, and the reduction ratio was higher in rural areas (80.7%) than in urban areas (58.9%) during the 25-year period;in 2013, the maternal mortality rate was 22.4/100 000 in urban areas and 23.6/100 000 in rural areas, with a gradually narrowed urban-rural gap.Conclusions In China, there are still urban-rural, regional, and population disparity in maternal mortality rate and the mortality rate is higher in rural areas, western regions than in urban areas and eastern regions and higher among migrant populations than among resident populations. The results suggest that special attentions should be paid to maternal health in rural areas, western regions, and among migrant populations.