The Turkey national maternal mortality study.

OBJECTIVE: Complications during pregnancy, delivery and puerperium are the most widespread causes of death and disability among women of reproductive age in developing countries. In most of these, reliable estimates of maternal mortality are lacking. This paper aims to report Turkey's basic maternal mortality indicators derived from the National Maternal Mortality Study (NMMS). METHODS: The data originate from NMMS which was an implementation of a Reproductive Age Mortality Study (RAMOS) data-collection strategy. Maternal mortality rates and ratios were estimated, and information was gathered for improving the existing recording and reporting systems. Burial data by age and sex were collected prospectively over a 12 month period. Interviews with household members, health care providers, and reviews of facility records were then used to classify the deaths as pregnancy-related or maternal or otherwise. RESULTS: A national pregnancy-related mortality ratio of 38 (+/- 2.8) and a maternal mortality ratio of 29 (+/- 2.5) per 100,000 live births were found. The NMMS shows that 59% of all pregnant women died from direct maternal causes, 16% from indirect causes and 23% from co-incidental causes. CONCLUSION: Maternal mortality is highest in regions with a poorer network of good roads, harsher winter conditions and longer distances to the next secondary level health facility which provides comprehensive obstetric emergency care services.