• X L Feng, J Zhu, L Zhang, L Song, D Hipgrave, S Guo, C Ronsmans, Y Guo, and Q Yang.
• Department of Health Policy and Administration, School of Public Health, Peking University, Beijing, China.
• BJOG. 2010 Nov 1; 117 (12): 1527-36.

ObjectiveChina's economic reforms have raised concerns over rising inequalities in maternal mortality, but it is not known whether the gap across socio-economic regions has increased over time.DesignA population-based, longitudinal, ecological correlation study.SettingChina.SampleRecords from the National Maternal and Child Mortality Surveillance System between 1996 and 2006.MethodsWe report levels, causes and timing of maternal deaths, and examine crude and adjusted time trends in the overall and cause-specific maternal mortality ratio in five socio-economic regions (using Poisson regression). We examine whether socio-economic disparities have widened over time using concentration curves.Main Outcome MeasuresAll-causes and cause-specific maternal mortality ratios.ResultsMaternal mortality (MMR) declined by 6% per year (yearly rate ratio, RR, 0.94; 95% CI 0.93-0.96). The decline was most pronounced in the wealthiest rural type-I counties (RR 0.89; 95% CI 0.85-0.93), and in the poorest rural type-IV counties (RR 0.90; 95% CI 0.82-1.00). There were declines in almost all causes of maternal death. Postpartum haemorrhage (PPH) was by far the leading cause of maternal death (32%, 997/3164). The decline in MMR was largely explained by the increased uptake of institutional births. Concentration curves suggest that wealth-related regional inequalities did not increase over time.ConclusionsChina's extraordinary economic growth has not adversely affected disparities in MMR across socio-economic regions over time, but poor rural women remain at disproportionate risk. Other emerging economies can learn from China's focus on the supply and quality of maternity services along with more general health systems strengthening.© 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

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