Duration and magnitude of mortality after pregnancy in rural Bangladesh

• Published in: International journal of epidemiology Vol. 37; no. 2; pp. 397 - 404
• Main Authors: Hurt, Lisa Sioned, Alam, Nurul, Dieltiens, Greet, Aktar, Nasrin, Ronsmans, Carine
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.04.2008; Oxford Publishing Limited (England)
• Subjects: Abortion induced; Abortion, Spontaneous; Adolescent; Adult; Bangladesh; Biological and medical sciences; Developing Countries; Epidemiology; Female; General aspects; Humans; Maternal Health Services - standards; Maternal Mortality; Medical sciences; Miscellaneous; parturition; post-partum period; Postpartum Period; Pregnancy; Pregnancy Complications - mortality; Pregnancy in Adolescence; pregnancy outcome; Public health. Hygiene; Public health. Hygiene-occupational medicine; Rural Population; Stillbirth; Asia; Bangladesh; abortion spontaneous; post-partum period; stillbirth; pregnancy outcome; Abortion induced; maternal mortality; parturition; Human; Rural environment; Stillborn; Prognosis; Health; Mortality; Spontaneous; Induced abortion; Duration; Puerperium; Epidemiology; Pregnancy; Mother; Evolution; Female; Delivery; Woman
• ISSN: 0300-5771; 1464-3685
• DOI: 10.1093/ije/dym274

Background Women remain at increased risk of mortality for some time after pregnancy although the length of this period is unclear. The aim of this study is to examine mortality after pregnancy in rural Bangladesh using data from a unique demographic surveillance system. Methods We included all person-time in women aged 15–50 between 1983 and 2001 and compared mortality rates by time since pregnancy outcome (live birth, stillbirth, induced and spontaneous abortion) using Poisson regression, adjusting for socio-demographic factors. Results Mortality was highest on the first day after pregnancy (adjusted RR compared with third to fourth year post-partum 105.74, 95% CI: 76.08, 146.95) and remained elevated until 180 days (adjusted RR 1.55, 95% CI: 1.13, 2.11). Pregnancies ending in abortions and stillbirths accounted for 50% of deaths in women within 6 weeks of the end of pregnancy, and mortality after these outcomes was between two and four times as high as mortality after a livebirth. Conclusion The high mortality rates immediately after birth provide strong support for a skilled attendance strategy. After abortions or stillbirths, women should be under surveillance for up to 1 week. Further work on the cause of deaths in the late post-partum period is required to understand the mechanisms behind increased mortality risks at these times.