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. 2015 Aug 3;10(8):e0132547.
doi: 10.1371/journal.pone.0132547. eCollection 2015.

Maternal Mortality in Taiwan: A Nationwide Data Linkage Study

Tung-Pi Wu  1 , Fu-Wen Liang  2 , Ya-Li Huang  3 , Lea-Hua Chen  4 , Tsung-Hsueh Lu  2
Affiliations

Maternal Mortality in Taiwan: A Nationwide Data Linkage Study

Tung-Pi Wu et al. PLoS One. .

Abstract

Background: To examine the changes in the maternal mortality ratio (MMR) and causes of maternal death in Taiwan based on nationwide linked data sets.

Methods: We linked four population-based data sets (birth registration, birth notification, National Health Insurance inpatient claims, and cause of death mortality data) to identify maternal deaths for 2004-2011. Subsequently, we calculated the MMR (deaths per 100,000 live births) and the proportion of direct and indirect causes of maternal death by maternal age and year.

Findings: Based on the linked data sets, we identified 236 maternal death cases, of which only 102 were reported in officially published mortality data, with an underreporting rate of 57% [(236-102) × 100 / 236]. The age-adjusted MMR was 18.4 in 2004-2005 and decreased to 12.5 in 2008-2009; however, the MMR leveled off at 12.6 in 2010-2011. The MMR increased from 5.2 in 2008-2009 to 7.1 in 2010-2011 for patients aged 15-29 years. Women aged 15-29 years had relatively lower proportion in dying from direct causes (amniotic fluid embolism and obstetric hemorrhage) compared with their counterpart older women.

Conclusions: Approximately two-thirds of maternal deaths were not reported in officially published mortality data. Routine surveillance of maternal mortality by using enhanced methods is necessary to monitor the health status of reproductive-age women. Furthermore, a comprehensive maternal death review is necessary to explore the preventability of these maternal deaths.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Number of identified maternal deaths from different data sets.
Fig 2
Fig 2. Age-adjusted maternal mortality ratios according to the linked data and officially published mortality data in Taiwan for 2004−2011.
Fig 3
Fig 3. Maternal mortality ratios according to the reproductive age in Taiwan for 2004–2011.
Fig 4
Fig 4. Causes of maternal death in Taiwan for 2004–2011.
See this image and copyright information in PMC

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