Urban-rural disparities in the trends and causes of maternal deaths in Jinan, 1991–2025

A longitudinal trend analysis

Bibliographic Data

ID22079271
AuthorsXiaoxia Zheng (Shandong Maternal and Child Health Hospital), Jiaxue Pan (Shandong Maternal and Child Health Hospital), Qian Sun (0000-0001-8556-2464, Shandong Maternal and Child Health Hospital), Yangyang Tan (Shandong Maternal and Child Health Hospital), Xingrong Ma (Jinan Maternity And Care Hospital), Zhongliang Li (0000-0002-7599-9328, Shandong Maternal and Child Health Hospital, corresponding author)
Year2026
Volume14
Pages1830524-1830524
Publication date2026-05-19
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2026.1830524
PMID42239014
OpenAlexW7161635589
LanguageEN
References cited37

Background: Differences in health resources between rural and urban areas were identified as an important factor hindering the further reduction of maternal mortality ratio (MMR). However, few studies were conducted to analyze the trends and causes between them. Jinan in eastern China was selected as the research site, and differences and trends in maternal deaths from 1991 to 2025 were analyzed to provide suggestions for government departments to formulate targeted measures. Methods: Data such as the number of live births, maternal deaths, and causes of deaths were collected from paper files, electronic sheets, and web-based information platforms in Jinan. The study period was divided into seven stages with 5-year as a cycle, and Joinpoint Regression Model was used to analyze the trends of maternal deaths in urban and rural areas. Results: A total of 2,115,657 live births and 370 maternal deaths were included from 1991 to 2025 in Jinan. The overall MMR was 17.49 per 100,000 live births, of which the rural MMR was 21.15 per 100,000 live births and the urban MMR was 10.68 per 100,000 live births. The MMR showed an overall downward trend, with average annual percent change (AAPC) of -4.72% (95% CI: -5.32, -4.11), -4.03% (95% CI: -4.64, -3.41), and -5.49% (95% CI: -6.22, -4.75) in the total population, rural areas, and urban areas, respectively. The main causes of maternal deaths were obstetric hemorrhage (OH), hypertensive disorders of pregnancy (HDP), amniotic fluid embolism (AFE), heart disease (HD), venous thrombosis and pulmonary embolism (VTE), hepatopathy (Hep), and puerperal infection (PI). A total of 129 avoidable maternal deaths were recorded from 1991 to 2025, with a higher proportion in rural areas than in urban areas (85.27 vs. 14.73%). The main causes of avoidable deaths were Individual, Family and Community (46.51%) and Health Facility (43.41%). Conclusion: Some achievements had been made in Jinan in reducing MMR. Pregnant women in rural areas still faced challenges in controlling MMR. Efforts to reduce MMR, the government should take comprehensive measures to improve health awareness in rural areas and address the weak rescue capacity of rural hospitals

Amniotic fluid embolism · Eclampsia · Live birth · Maternal death · Pregnancy · Public health · Rural area · Standardized mortality ratio · Trend analysis · COVID-19 Impact on Reproduction · Global Maternal and Child Health · Maternal and fetal healthcare

Tools

Open DOIOpen Access