1994-2013年我国孕产妇死亡率及其与孕产保健服务利用的关系

目的:了解我国孕产妇死亡率(MMR)、孕产保健利用率变化趋势,探究两者关系,为进一步降低我国MMR提供参考。方法:挖掘《中国卫生统计年鉴》及中国妇幼卫生相关监测数据,采用灰色关联分析探讨孕产妇死亡水平与孕产保健利用率关联性。结果:1994-2013年全国MMR由64.8/10万降至23.2/10万(下降64.2%),降幅农村高于城市;死因产科出血仍居第1位,羊水栓塞上升至第2位。孕产保健利用率上升,升幅农村高于城市,其中住院分娩率上升最快。关联分析显示全国和农村MMR与六项孕产保健利用率均呈明显负相关关系(P<0.01),城市MMR仅与住院分娩率呈显著负相关关系(P<0.01)。存在问题:MMR地区差异仍然存在;流动人口成为孕产保健重点人群。结论:二十年来我国MMR下降明显,但随着孕产保健利用效应最大化,未来仅依靠提高住院分娩率等措施来降低MMR的作用已非常有限,需思考新的策略与措施。

The relationship between maternal mortality rate and maternal health care utilization from 1994 to 2013

Objective:To investigate the trend of Chinese maternal mortality rate( MMR) and maternal health care utilization,and its relation for providing the reference in decreasing the MMR. Methods:The related data from China Health Statistics Year book and China maternal and child health monitoring report were collected to analyze the relationship between MMR and maternal health care utilization using grey correlation. Results:The MMR in 1994 to 2013 year declined from 64. 8 to 23. 2 each 100 thousand( decline for 64. 2%),the decreasing degree of which in rural was higher than that in city. The morrhage and amniotic fluid embolism was the first and second cause of death. The maternal health care utilization increased,the increasing degree of which in rural was higher than that in city,the rise of hospital birth rate was the most quickly. The correlation analysis showed the MMR in rural was significantly negative correlation with 6 items of maternal health care utilization(P<0. 01),the MMR in city was significantly negative correlation with the hospital birth rate(P<0. 01). The difference of MMR in different area was a problem,the floating population was the focus of maternity care population. Conclusions:The decrease of maternal mortality rate in the last 20 years is significant. With the expanding of maternal health care utilization, the effect of increasing the hospital birth rate on the decreasing the MMR is limit, and new strategies and measures are needed.