Population Council, New York, New York, United States of America.
PLoS One. 2013 Apr 16;8(4):e59864. doi: 10.1371/journal.pone.0059864. Print 2013.
With recent results showing a global decline in overall maternal mortality during the last two decades and with the target date for achieving the Millennium Development Goals only four years away, the question of how to continue or even accelerate the decline has become more pressing. By knowing where the risk is highest as well as where the numbers of deaths are greatest, it may be possible to re-direct resources and fine-tune strategies for greater effectiveness in efforts to reduce maternal mortality.
We aggregate data from 38 Demographic and Health Surveys that included a maternal mortality module and were conducted in 2000 or later to produce maternal mortality ratios, rates, and numbers of deaths by five year age groups, separately by residence, region, and overall mortality level.
The age pattern of maternal mortality is broadly similar across regions, type of place of residence, and overall level of maternal mortality. A "J" shaped curve, with markedly higher risk after age 30, is evident in all groups. We find that the excess risk among adolescents is of a much lower magnitude than is generally assumed. The oldest age groups appear to be especially resistant to change. We also find evidence of extremely elevated risk among older mothers in countries with high levels of HIV prevalence.
The largest number of deaths occurs in the age groups from 20-34, largely because those are the ages at which women are most likely to give birth so efforts directed at this group would most effectively reduce the number of deaths. Yet equity considerations suggest that efforts also be directed toward those most at risk, i.e., older women and adolescents. Because women are at risk each time they become pregnant, fulfilling the substantial unmet need for contraception is a cross-cutting strategy that can address both effectiveness and equity concerns.
最近的研究结果表明，在过去二十年中全球产妇死亡率整体呈下降趋势，而距离实现千年发展目标的截止日期仅剩四年，因此如何继续甚至加速这一下降趋势变得更为紧迫。通过了解风险最高的地区以及死亡人数最多的地区，我们或许可以重新调配资源，并调整策略，以提高降低产妇死亡率工作的成效。
我们汇总了 2000 年或之后进行的 38 项人口与健康调查的数据，这些调查都包含孕产妇死亡率模块，以便按居住地点、地区和总体死亡率水平，分别按 5 岁年龄组汇总孕产妇死亡率比、比率和死亡人数。
各地区、居住地点类型和总体死亡率水平的孕产妇死亡率年龄模式大致相似。所有组都存在“J”形曲线，30 岁以后风险明显增加。我们发现，青少年的超额风险远低于普遍假设的水平。最年长的年龄组似乎尤其难以改变。我们还发现，艾滋病毒流行率高的国家中老年产妇的风险极高。
死亡人数最多的年龄组为 20-34 岁，这主要是因为该年龄段女性生育的可能性最大，因此针对这一年龄组的努力将最有效地减少死亡人数。然而，公平性考虑表明，还应针对风险最高的群体，即老年妇女和青少年，开展工作。由于女性每次怀孕都面临风险，因此满足避孕的大量未满足需求是一项具有普遍意义的战略，可以解决效果和公平性问题。
