The role of pregnancy outcomes in the maternal mortality rates of two areas in Matlab, Bangladesh.

CONTEXT The Matlab Maternal Child Health-Family Planning (MCH-FP) project provides maternity care as part of its reproductive health services. It is important to assess whether this project has reduced maternal mortality and, if so, whether this was due to differences between the MCH-FP area (which received project services) and the comparison area (which did not) in pregnancy rates, pregnancy outcomes or case-fatality rates. METHODS Data from the Matlab Demographic Surveillance System on 165,894 pregnancies over the period 1982-2005 were used to calculate four measures of maternal mortality for the MCH-FP and comparison areas. Mortality risk was examined by type of pregnancy outcome and by area, and bivariate and logistic regression analyses were used to generate unadjusted and adjusted odds ratios, respectively. RESULTS The maternal mortality rate of 35 deaths per 100,000 women of reproductive age in the MCH-FP area was 37% lower than that in the comparison area (56 deaths per 100,000). In both areas, the maternal mortality risk was considerably higher for pregnancies that ended in induced abortion, miscarriage or stillbirth than for those that resulted in live birth (odds ratios, 4.2, 2.0 and 17.4, respectively). The difference in maternal mortality rates between the two areas was mainly a result of the MCH-FP area's lower pregnancy rate and its lower case-fatality rates for induced abortions, miscarriages and stillbirths. CONCLUSIONS Interventions to increase contraceptive use; to reduce the incidence of induced abortion, miscarriage and stillbirth; to improve the management of such outcomes; and to strengthen antenatal care could substantially reduce maternal mortality in Bangladesh and similar countries.