More Realistic Estimate for Maternal Mortality Ratio in Iran

In 2010, two reports have provided estimates of maternal mortality ratios (MMR) for different countries (1, 2). Hogan et al. have reported a decreasing trend for MMR in Iran from 101 (per 100000 live births) in 1980, 64 in 1995, and 36 in 2000 to 28 in 2008 (1). In the World Health Statistics 2010, two different estimates have been provided for most of the countries; one countryreported and one inter-agency estimate. Those estimates for Iran (reference year: 2005) are 25 and 140 (95 CI: 95-190) respectively (2). The inter-agency estimates refers to the report developed by WHO, UNICEF, UNFPA and The World Bank; they applied the proportion of maternal deaths among females of reproductive age (PMDF) to the WHO estimates of reproductive-aged female deaths for the respective year to obtain the total number of maternal deaths for Iran (3). In the earlier versions of World Health Statistics (before 2008), MMR for Iran had been reported 76 based on inter-agency estimate in 2000 (4). The estimate of World Health Statistics is neither consistent with the trend of national estimates nor comparable with their absolute numbers. Data derived from the health information system of rural areas of Iran which provides relatively valid data for some important health indices (5) shows a decreasing trend for MMR (Fig. 1); actually, the inter-provincial disparities are more serious concern in the field of pregnancy-related issues in Iran (6). It seems that the inter-agency estimate for Iran MMR does not reflect the real situation of maternal mortality and is not confirmed by the other available evidences. Hogan et al. have reported more realistic estimate for MMR at least for Iran.