Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Jul 29:11:606.
doi: 10.1186/1471-2458-11-606.

The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health

Saffron Karlsen  1 , Lale Say, João-Paulo Souza, Carol J Hogue, Dinorah L Calles, A Metin Gülmezoglu, Rosalind Raine
Affiliations

The relationship between maternal education and mortality among women giving birth in health care institutions: analysis of the cross sectional WHO Global Survey on Maternal and Perinatal Health

Saffron Karlsen et al. BMC Public Health. .

Abstract

Background: Approximately one-third of a million women die each year from pregnancy-related conditions. Three-quarters of these deaths are considered avoidable. Millennium Development Goal five calls for a reduction in maternal mortality and the establishment of universal access to high quality reproductive health care. There is evidence of a relationship between lower levels of maternal education and higher maternal mortality. This study examines the relationship between maternal education and maternal mortality among women giving birth in health care institutions and investigates the association of maternal age, marital status, parity, institutional capacity and state-level investment in health care with these relationships.

Methods: Cross-sectional information was collected on 287,035 inpatients giving birth in 373 health care institutions in 24 countries in Africa, Asia and Latin America, between 2004-2005 (in Africa and Latin America) and 2007-2008 (in Asia) as part of the WHO Global Survey on Maternal and Perinatal Health. Analyses investigated associations between indicators measured at the individual, institutional and country level and maternal mortality during the intrapartum period: from admission to, until discharge from, the institution where women gave birth. There were 363 maternal deaths.

Results: In the adjusted models, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Institutional capacity was not associated with maternal mortality in the adjusted model. Those not married or cohabiting had almost twice the risk of death of those who were. There was a significantly higher risk of death among those aged over 35 (compared with those aged between 20 and 25 years), those with higher numbers of previous births and lower levels of state investment in health care. There were also additional effects relating to country of residence which were not explained in the model.

Conclusions: Lower levels of maternal education were associated with higher maternal mortality even amongst women able to access facilities providing intrapartum care. More attention should be given to the wider social determinants of health when devising strategies to reduce maternal mortality and to achieve the increasingly elusive MDG for maternal mortality.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Distribution of maternal deaths by years of maternal education.
See this image and copyright information in PMC

References

    1. World Health Organisation. Trends in maternal mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva: WHO; 2010.
    1. Wagstaff A, Claeson M. The Millennium Development Goals for health: rising to the challenges. World Bank; 2004.
    1. Anderson T. How can child and maternal mortality be cut? BMJ. 2010;340:c431. doi: 10.1136/bmj.c431. - DOI - PubMed
    1. Backman G, Hunt P, Khosla R, Jaramillo-Strauss C, Fikre BM, Rumble C, Pevalin D, Páez DA, Pineda MA, Frisancho A, Tarco D, Motlagh M, Farcasanu D, Vladescu C. Health systems and the right to health: an assessment of 194 countries. Lancet. 2008;372:2047–2085. doi: 10.1016/S0140-6736(08)61781-X. - DOI - PubMed
    1. Hunt P. Report of the UN Special Rapporteur on the right to the highest attainable standard of health to the United Nations General Assembly. UN Doc A/61/338. New York: United Nations; 2006.

Publication types