Abstract
BackgroundDisparity in maternal mortality exists between rural–urban migrant and urban resident women in China, but little research has provided evidence for related policy development. The objective of this study was to identify associations with and risks for maternal death among rural–urban migrant women in order to improve health services for migrant women and reduce maternal mortality in China.MethodsWe conducted a prospective case–control study in urban areas of Guangdong, Zhejiang and Fujian provinces and Beijing municipality. In each, migrant women who died between July 1, 2010 and October 1, 2011 were identified through reports from China’s Maternal and Child Mortality Surveillance System. For each, four matched controls were selected from migrant women who delivered in local hospitals during the same period. We compared socio-demographic characteristics, health status and health service variables between cases and controls, and used bivariate and multivariate conditional logistic regression analyses to determine associations with and risk factors for maternal death.Results109 cases and 436 controls were assessed. Family income <2000 yuan per month (OR = 4.5; 95% CI 1.7-11.7) and lack of health insurance (OR = 1.3; 95% CI 1.1-1.6) were more common amongst women who died, as were lack of antenatal care (ANC) (OR = 22.3; 95% CI 4.3-116.0) and attending ANC only 1–4 times (OR = 5.0; 95% CI 1.6-15.5). Knowledge of danger signs during delivery was less common in this group (OR = 0.3; 95% CI 0.1-0.8).ConclusionDifferences existed between migrant women who died in pregnancy and surviving controls. The identified risk factors suggest strategies for health sector and community action on reducing maternal mortality among migrant women in China. A systematic approach to maternity care for rural–urban migrant women is recommended.
Highlights
Disparity in maternal mortality exists between rural–urban migrant and urban resident women in China, but little research has provided evidence for related policy development
China’s migrant workers consistently underuse health services in their destination cities [6,7]; fewer migrant than resident women attend antenatal care (ANC) and fewer deliver in a hospital, even in large cities which have had many years to establish services for them [8,9,10]
A total of 135 migrant maternal deaths occurred during the study period and 109 were enrolled in our study
Summary
Disparity in maternal mortality exists between rural–urban migrant and urban resident women in China, but little research has provided evidence for related policy development. The objective of this study was to identify associations with and risks for maternal death among rural–urban migrant women in order to improve health services for migrant women and reduce maternal mortality in China. China’s MMR decreased much less in urban than rural areas due to deaths among rural–urban migrant women [2]. A study from Shanghai showed that 79% of maternal deaths during 2000–2009 were among migrant women, when their share of the city’s population. Poor uptake of services by and lack of health insurance among rural–urban migrants place them at risk. Migrants may have no entitlement to or difficulty accessing medical care [12], or may lack knowledge of services to which they are entitled [13]
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