Inequality in Maternal Mortality in Iran: An Ecologic Study

Abstract

Background: Maternal mortality (MM) is an avoidable death andthere is national, international and political commitment to reduceit. The objective of this study is to examine the relation of MM tosocioeconomic factors and its inequality in Iran’s provinces at anecologic level.Methods: The overall MM from each province was considered for3 years from 2004 to 2006. The five independent variables whoserelations were studied included the literacy rate among men andwomen in each province, mean annual household income per capita,Gini coefficients in each province, and Human Development Index(HDI). The correlation of Maternal Mortality Ratio (MMR) to theabove five variables was evaluated through Pearson’s correlationcoefficient (simple and weighted for each province’s population) andlinear regression – by considering MMR as the dependent variableand the Gini coefficient, HDI, and difference in literacy rate amongmen and women as the independent variables.Results: The mean MMR in the years 2004–2006 was 24.7 in100,000 live births. The correlation coefficients between MMRand literacy rate among women, literacy rate among men, themean annual household income per capita, Gini coefficient andHDI were 0.82, 0.90, −0.61, 0.52 and −0.77, respectively. Basedon multivariate regression, MMR was significantly associated withHDI (standardized B=−0.93) and difference in literacy rate amongmen and women (standardized B=−0.47). However, MMR was notsignificantly associated with the Gini coefficient.Conclusion: This study shows the association betweensocioeconomic variables and their inequalities with MMR in Iran’sprovinces at an ecologic level. In addition to the other directinterventions performed to reduce MM, it seems essential toespecially focus on more distal factors influencing MMR.Keywords: Ecologic study, inequality, Iran, maternal mortality