Abstract
BackgroundThe maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development. Although China has experienced a large decline in MMR, substantial disparities across regions are still apparent. This study aims to explore causes of socioeconomic related inequality in MMR at the province-level in China from 2004 to 2016.MethodsWe collected data from various issues of the China Health Statistics Yearbook, China Statistics Yearbook, and China Population and Employment Statistics Yearbook to construct a longitudinal sample of all provinces in China. We first examined determinants of the MMR using province fixed-effect models, accounted for socioeconomic condition, health resource allocation, and access to health care. We then used the concentration index (CI) to measure MMR inequality and employed the direct decomposition method to estimate the marginal impact of the determinants on the inequality index. Importance of the determinants were compared based on logworth values.ResultsDuring our study period, economically more deprived provinces experienced higher MMR than better-off ones. There was no evidence of improved socioeconomic related inequality in MMR. Illiteracy proportion was positively associated with the MMR (p < 0.01). In contrast, prenatal check-up rate (p = 0.05), hospital delivery rate (p < 0.01) and rate of delivery attended by professionals (p = 0.02) were negatively associated with the MMR. We also find that higher maternal health profile creation rate (p < 0.01) was associated with a pro-poor change of MMR inequality.ConclusionAccess to healthcare was the most important factor in explaining the persistent MMR inequality in China, followed by socioeconomic condition. We do not find evidence that health resource allocation was a contributing factor.
Highlights
The maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development
Between-province variation was generally larger for most variables, we observed sufficient changes across time in a given province, which we exploited for the identification of the marginal effects of these variables on the MMR and individual components of the inequality indicator
MMR decreased in almost all provinces, apparent distinctions between more developed eastern and less developed western areas can still be observed across years, suggesting that such regional disparities have been associated with socioeconomic levels
Summary
The maternal mortality ratio (MMR) is an important indicator of maternal health and socioeconomic development. The maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births, is an important indicator of maternal health as well as socioeconomic development in a country or region [1]. In 2016, Tibet (a less-developed province in western China) has an MMR level (109.9/100,000) that is 5.5 times of the national average and 50 times of the Jiangsu province (a well-developed province in eastern China) (2.2/ 100,000). These numbers suggest persistent disparities associated with socioeconomic conditions, which has posed great challenges to the central and local governments of China in pursuing health equality [6, 7]
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