Inequality in Maternal Mortality in Iran: An Ecologic Study

BACKGROUND Maternal mortality (MM) is an avoidable death and there is national, international and political commitment to reduce it. The objective of this study is to examine the relation of MM to socioeconomic factors and its inequality in Iran's provinces at an ecologic level. METHODS The overall MM from each province was considered for 3 years from 2004 to 2006. The five independent variables whose relations were studied included the literacy rate among men and women 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 the above five variables was evaluated through Pearson's correlation coefficient (simple and weighted for each province's population) and linear regression - by considering MMR as the dependent variable and the Gini coefficient, HDI, and difference in literacy rate among men and women as the independent variables. RESULTS The mean MMR in the years 2004-2006 was 24.7 in 100,000 live births. The correlation coefficients between MMR and literacy rate among women, literacy rate among men, the mean annual household income per capita, Gini coefficient and HDI were 0.82, 0.90, -0.61, 0.52 and -0.77, respectively. Based on multivariate regression, MMR was significantly associated with HDI (standardized B=-0.93) and difference in literacy rate among men and women (standardized B=-0.47). However, MMR was not significantly associated with the Gini coefficient. CONCLUSION This study shows the association between socioeconomic variables and their inequalities with MMR in Iran's provinces at an ecologic level. In addition to the other direct interventions performed to reduce MM, it seems essential to especially focus on more distal factors influencing MMR.