Academic journal article Journal of Health Population and Nutrition

Maternal Deaths and Their Causes in Ankara, Turkey, 1982-2001

Academic journal article Journal of Health Population and Nutrition

Maternal Deaths and Their Causes in Ankara, Turkey, 1982-2001

Article excerpt


Maternal mortality ratio represents the level of healthcare services, social welfare, and economic affluence of a community (1). The World Health Organization (WHO) estimates that about 500,000 women in developing countries die each year due to pregnancy-related complications where maternal mortality accounts for 99% of the world's maternal deaths (2-4).

Of all indicators used today for comparing levels of development between countries and regions, maternal mortality shows the widest disparities (2,5).

In developing countries, not all maternal deaths are reported and, thus, national mortality ratios obtained by analysis of death registrations are under-estimated (3,6,7). This is a problem even in developed countries. Although teaching hospital statistics do not present national maternal mortality ratios, they are usually more accurate and can usefully be compared with rates in similar institutions in developed countries. The contrast is stark (8).

Data obtained can be used for developing policies for reducing maternal mortality rates by increasing the quality of prenatal and obstetric care and for determining trends over a period of time.

The aim of the study was to analyze the aetiology and incidence of maternal deaths over a 20-year period at the Zekai Tahir Burak Women's Education and Research Hospital (ZTBWHERH) in Ankara, Turkey.


The study was carried out in Ankara, the capital city of Turkey. Turkey, a developing country, has a population of 67,803,927. Three-fifths of its population live in urban centres, while the rest live in largely poor rural areas. Ankara, the second largest city in Turkey, has a population of 4,007,860 (9). The city lies in the Middle Anatolia region of Turkey. Crude birth rates of Turkey and Ankara are 21.3% and 19.93% respectively. The total fertility rates of Turkey and Ankara are 2.46 and 1.9 per 1,000 women of reproductive age respectively.

Essential obstetric care is provided in 5 university hospitals, 3 government tertiary hospitals, 29 government district hospitals, 12 private hospitals, and 189 primary care institutions (10).

Maternal mortality in Turkey has decreased dramatically during the past half century from 208 maternal deaths per 100,000 livebirths in 1974 to 49 maternal deaths per 100,000 livebirths in 2001 (7,9) .

Data on maternal mortality rates in Ankara, referral rates from rural areas to urban areas of Ankara, and rates of deaths occurring at home were unfortunately not available.

The study was carried out at ZTBWHERH. ZTBWHERH, a teaching hospital of the Ministry of Health, has 500 inpatient beds and is located in Ankara. The hospital is also a perinatal referral centre for approximately 33 counties and several villages in Central Anatolia. 60.2% of births in Central Anatolia take place in hospital, and the rest are reported as home deliveries (11). In Ankara and its vicinity, over the period of study, 37.4% of births in hospital occurred at ZTBWHERH (10). The annual proportion ranges from 32.1% to 42.5%. No patient is refused admission. The study population included patients who delivered (or terminated) at ZTBWHERH and included those who were transferred here after delivery elsewhere. Data were identified by reviewing all deaths of women of reproductive age that occurred in the hospital and by reviewing medical records.

During January 1982-July 2001, 177 maternal deaths and 430,559 livebirths were registered. Three of the 177 deaths were due to trauma, unrelated to pregnancy (multiple abdominal organ perforations, intra-abdominal haemorrhage due to rupture of the spleen, and intra-cranial haemorrhage), and were excluded from analysis.

Data on maternal deaths were obtained from hospital records, death registration lists, and patient files. We did not have the ability to track women who had delivered at ZTBWHERH and may have died at another hospital. …

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