Risk factors effecting the preventability of maternal mortality between 2007-2009 In Turkey

As a multidimensional finding of development, maternal mortality (MM) level has a close correlation with reproproductive health policy and quality of service. Many research has shown that maternal death occuring during the pregnancy, delivery and postpartum period could be preventable.The aim of our study is to evaluate the preventability of these reported maternal deaths and to investigate the leading risk factors in that three-year period.In this cross-sectional research, we investigated 780 maternal death that was reported to Ministry of Health in the years of 2007, 2008 and 2009 and analyzed the preventable risk factors of maternal death.The results showed that MM rate was the highest (30.5%) in mothers aged 35 and more. However the fertility rate in adolescence is still high in our country, in the meantime, MM rate in adolescence (ages, 15-19 yrs) was decreasing. We should strenghten our policies to prevent pregnancy in women under 19 and over 34 year-old.One in four of the maternal deaths occured in the first pregnancy and one in three maternal deaths was in the first delivery. Risk groups are women with four or more pregnancy, nullipars with compromised pregnancy and those who delivered but had no live child. These should be the most priviledged groups in prenatal care services.In this cohort, the ratio of Casearian Section was 61.7% in women who delivered. Maternal deaths were more preventable in women who had a vaginal delivery. This result showed that indications and timing of Casearian Section needs to be reviewed in detail.71% of the mothers who died, had at least one risk. In three years, 46% of the MM had delay and those were preventable. Preventability of the deaths were higher in direct MM by 2-fold, MM at home or during transfer by 3.1-fold, absence of prenatal care by 2.2-fold and presence of at least one risk by 1.9-fold.Mother and Child Health actions within the Programs of Family Planning and Safe Motherhood in the last three decades, and Health Transformation Program since 2002 improved the mother and child health determinants in the last 15 years. In the content of Health Transformation Program, Family Medicine Implementation established across the country, should be considered as an oppurtinity for family planning and mother and child health and logistics of supplies and services should be planned properly.What we have to do in avoiding all delay models for MM is actually very clear as we see in other countries? models. We should reinforce both basic school education and health education during the reproductive age especially for women in risk groups, avoid high risk pregnancy and eliminate home delivery totally. The curriculum of academic training, residency and in-service training for health professionals should be strengthen in the aspects of obstetric emergency and practice. Arrangement of the perinatal care centers - an ongoing plan at present - should be the most critical point in the preventability of MM.