Avoidable Factors Contributing to Maternal Deaths in Turkey

  • İlknur Yüksel-KaptanoğluEmail author
  • Ahmet Sinan Türkyılmaz
  • İsmet Koç
Part of the European Studies of Population book series (ESPO, volume 18)


Women’s deaths during pregnancy or 42 days after the termination of pregnancy are called maternal deaths. For developing countries, maternal deaths continue to be significant in number. This study represents the avoidable factors contributing to maternal deaths in Turkey using the results of the National Maternal Mortality Study conducted in 2005. According to this nationally representative study, the maternal mortality ratio is 29 per 100,000 live births which is lower than for all regions of the developing world, and at about the same level as those of the Commonwealth of Independent States (CIS) and East Asia. In this study, avoidable factors are categorized into four groups: household and community factors, health service provider factors, health service supply factors and other avoidable factors. The results indicate two striking findings. Firstly, the significant impact of household and community level factors on maternal mortality compared to the impact of health service providers and health supply factors. This finding indicates that women’s position in their community and in their household is the most problematic issue when it comes to preventing maternal deaths. The second striking result of this study is that there exists a clear need to adopt different strategies for the elimination of maternal deaths in different localities and regions. Although the impact of health service supply factors on maternal mortality were limited among the avoidable factors, the problems of reaching health facilities due to a lack of transportation and long distances between home and the health facility were frequently mentioned obstacles in rural areas.


Maternal mortality Turkey Survey Risk factors Death register 



The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was conducted by the consortium of ICON-Institute Public Sector GmbH, Hacettepe University Institute of Population Studies (HUIPS), and BNB Consulting Ltd. Co., with the financial support of the European Commission. The research team con­sisted of the key experts Rudolf Schumacher, İsmet Koç, Oona Campbell and A. Sinan Türkyılmaz.


  1. Adamu, Y. M., Salihu, H. M., Sathiakumar, N., & Alexander, G. R. (2003). Maternal mortality in Northern Nigeria: A population-based survey. European Journal of Obstetrics and Gynecology and Reproductive Biology, 109, 153–159.CrossRefGoogle Scholar
  2. Akin, A., Dogan, B., & Mıhcıokur, S. (2000). Survey on causes of maternal mortalities from the hospital records in Turkey, report submitted to the Ministry of Health General Directorate of mother and Child Health and Family Planning.Google Scholar
  3. Aksit, B. (1993). Rural health seeking: Under fives in Sivas, Van and Ankara. In P. Stirling (Ed.), Culture and economy: Changes in Turkish villages (pp. 156–171). England: The Eothen Press.Google Scholar
  4. Alves, S. V. (2007). Maternal mortality in Pernambuco, Brazil: What has changed in ten years? Reproductive Health Matters, 15(30), 134–144.CrossRefGoogle Scholar
  5. Amarin, Z., Khader, Y., Okour, A., Jaddou, H., & Al-Qutob, H. (2010). National maternal mortality ratio for Jordan, 2007–2008. International Journal of Gynecology and Obstetrics, 111, 152–156.CrossRefGoogle Scholar
  6. Arriaga, E. E. (1994). Population analysis with microcomputers (Vol. 1, p. 153). New York: Bureau of Census, USAID and UNFPA.Google Scholar
  7. Bano, N., Chaudhri, R., Yasmeen, L., Shafi, F., & Ejaz, L. (2011). A study of maternal mortality in 8 principal hospitals in Pakistan in 2009. International Journal of Gynecology and Obstetrics, 114(2011), 255–259.CrossRefGoogle Scholar
  8. Barnes-Josiah, D., Myntti, C., & Augustin, A. (1998). The ‘three delays’ as a framework for examining maternal mortality in Haiti. Social Science and Medicine, 46(8), 981–993.CrossRefGoogle Scholar
  9. Berer, M. (2007). Maternal mortality and morbidity: Is pregnancy getting safer for women? Reproductive Health Matter, 15(309), 6–16.Google Scholar
  10. Biliker, M. A. (2005). Maternal mortality in Turkey. Journal of Perinatal Medicine, 31(5), 380–385.Google Scholar
  11. Bloom, S. S., Wypij, D., & Das Gupta, M. (2001). Dimensions of women’s autonomy and the influence on maternal health care utilization in a North Indian city. Demography, 38(1), 67–78.CrossRefGoogle Scholar
  12. Caldwell, J. C. (1986). Routes to Low mortality in poor countries. Population and Development Review, 3, 137–157.Google Scholar
  13. Campbell, O., & Ronsman, C. (1995). Report of a WHO workshop on verbal autopsy. WHO Document, World Health Organization, Geneva.Google Scholar
  14. Cham, M., Sundby, J., & Vangen, S. (2005). Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reproductive Health, 2(3), 1–8.Google Scholar
  15. Chandramohan, D., Maude, G. H., Rodriguez, L. C., & Hayes, R. J. (1998). Verbal autopsies for adult deaths: Their development and validatiın in a multicentre stduy. Tropical Medicine and International Health, 3(6), 436–446.CrossRefGoogle Scholar
  16. Conseil Sante, Sofreco, & Eduser. (2007). Sağlık Araştırma Davranışı Araştırması (Health Seeking Behaviour Research). Sağlık Bakanlığı Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü ve Avrupa Komisyonu Türkiye Delegasyonu, Ankara.Google Scholar
  17. Farhat, E. B., Chaouch, M., Chelli, H. F., Gara, M., Boukraa, N., Garbouj, M., Hamrouni, M., Fourati, A., Calvez, T., & Thonneau, P. (2011). Reduced maternal mortality in Tunisia and voluntary commitment to gender-related concerns. International Journal of Gynecology & Obstetrics, doi:10.1016/j.ijgo.2011.10.010.Google Scholar
  18. Fortney, J. A., Sussanti, I., Gadalla, S., Saleh, S., Rogers, S. M., & Potts, M. (1986). Reproductive mortality in two developing countries. American Journal of Public Health, 76(134), 38.Google Scholar
  19. Geynisman, J., Latimer, A., Ofosu, A., & Anderson, F. W. J. (2011). Improving maternal mortality reporting at the community level with a 4-question modified reproductive age mortality survey (RAMOS). International Journal of Gynecology and Obstetrics, 114(2011), 29–32.CrossRefGoogle Scholar
  20. Hogan, M. C., Foreman, K. J., Naghavi, M., Ahn, S. Y., Wang, M., Makela, S. M., Lopez, A. D., Lozano, R., & Murrap, C. J. L. (2010). Maternal mortality for 181 countries, 1980–2008: A systematic analysis of progress toward Millennium Development Goal 5. Lancet, 375(9726), 1609–1623.CrossRefGoogle Scholar
  21. Kao, S., Chen, L. M., Shi, L., & Weinrich, M. C. (1997). Under-reporting and misclassification of maternal mortality in Taiwan. Acta Obstetricia et Gynecologica Scandinavica, 76(7), 629–636.CrossRefGoogle Scholar
  22. Khan, S. K., Wodlyla, D., Say, L., Gulmezoglu, A. M., & Van Look, P. F. (2006). WHO analysis of causes of maternal deaths: A systematic review. Lancet, 367, 1066–1074.CrossRefGoogle Scholar
  23. Hacettepe University Institute of Population Studies (HUIPS). (2004). 2003 Turkey demographic and health survey. Ankara: Hacettepe University Institute of Population Studies, Ministry of Health, General Directorate of Mother and Child Health and Family Planning, State Planning Organization and European Union.Google Scholar
  24. Hacettepe University Institute of Population Studies (HUIPS). (2009). 2008 Turkey demographic and health survey. Ankara: Hacettepe University Institute of Population Studies, Ministry of Health, General Directorate of Mother and Child Health and Family Planning, State Planning Organization and TUBITAK.Google Scholar
  25. Hacettepe University Institute of Population Studies (HUIPS), & ICON-INSTITUT Public Sector GmbH and BNB Consulting. (2006). National maternal mortality study 2005. Ministry of Health, General Directorate of Mother and Child Health and Family Planning and Delegation of European Commission to Turkey.Google Scholar
  26. McCarthy, M., & Maine, D. (1992). A framework for maternal mortality. Studies in Family Planning, 23, 23–33.CrossRefGoogle Scholar
  27. Mungra, A., van Bokhoven, S. C., Florie, J., Van Kanten, R. W., van Roosmalen, J., & Kanhai, H. H. H. (1998). Reproductive age mortality survey to study under-reporting of maternal mortality in Surinam. European Journal of Obstetrics & Reproductive Biology, 77, 37–39.CrossRefGoogle Scholar
  28. Mbonye, A. K. (2001). Risk factors associated with maternal deaths in health units in Uganda. African Journal of Reproductive Health/La Revue Africaine de la SantéReproductive, 5(3), 47–53 (Published by: Women’s Health and Action Research Centre).Google Scholar
  29. Olsen, B. E., Hinderaker, S. G., Lie, R. T., Bergsjø, P., Gasheka, P., & Kvåle, G. (2002). Maternal mortality in northern rural Tanzania: Assessing the completeness of various information sources. Acta Obstetricia et Gynecologica Scandinavica, 81(4), 301–307.CrossRefGoogle Scholar
  30. Santow, G. (1995). Social roles and physical health: The case of female disadvantage in poor countries. Social Science and Medicine, 40, 147–161.CrossRefGoogle Scholar
  31. Songane, F. F., & Bergstrom, S. (2002). Quality of registration of maternal deaths in Mozambique: A community-based study in rural and urban areas. Social Science and Medicine, 54(1), 23–31.CrossRefGoogle Scholar
  32. Stanton, C., Hobcraft, J., & Hill, K., et al (2001). Every death counts: Measurement of maternal mortality via a census. Bulletin of the World Health Organization, 79(7), 657–664.Google Scholar
  33. State Institute of Statistics (SIS). (1978). Turkish demographic survey 1974–1975, State Institute of Statistics, Prime Ministry of Republic of Turkey, SIS Publication No. 841, Ankara.Google Scholar
  34. State Institute of Statistics (SIS). (1993). 1989 Turkish demographic survey. State Institute of Statistics, Prime Ministry of Republic of Turkey, Ankara.Google Scholar
  35. Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science and Medicine, 38(8), 1091–1110.CrossRefGoogle Scholar
  36. Turkyılmaz, A. S., Koç, I., Schumacher, R., & Campbell, O. M. R. (2009). The Turkey national maternal mortality study. The European Journal of Contraception and Reproductive Health Care, 14(1), 75–82.CrossRefGoogle Scholar
  37. Walraven, G., Telfer, M., Rowley, J., & Ronsmans, C. (2000). Maternal mortality in rural gambia and contributing factors. Bulletin of the World Health Organization, 78(5), 603–613.Google Scholar
  38. World Health Organization (WHO). (1992). International Statistical Classification of Diseases and Related Health Problems. Tenth Revision. Vol (1): Tabular list. Vol (2): Instruction manual. Geneva.Google Scholar
  39. World Health Organization (WHO). (1996). Revised 1990 estimates of maternal mortality: A new approach by WHO and UNICEF. World Health Organization and United Nations Children’s Fund, Geneva.Google Scholar
  40. World Health Organization (WHO). (2003). Global burden of hypertensive disorders of pregnancy in the year 2000, prepared by Carmen Dolea and Caelo AbouZahr. Geneva: World Health Organization.Google Scholar
  41. World Health Organization (WHO). (2004). Beyond the numbers: reviewing maternal deaths and complication to make pregnancy safer. Geneva: World Health Organization. http://whqlibdoc.whoint/publications/2004/9241591838.pdf (Accessed 25.01.2012).Google Scholar
  42. World Health Organization (WHO), UNICEF, & UNFPA. (2004). Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. Department of Reproductive Health and Research. Geneva: World Health Organization. (Accessed 25.01.2012).
  43. WHO, UNICEF, UNFPA, & The World Bank. (2010). Trends in maternal mortality: 1990–2008. Geneva: World Health Organization (Accessed 03.12.2011).Google Scholar
  44. Zahr, A. C., & Royston, E. (1991). Maternal mortality: A global factbook. Geneva: WHO. ISBN 92-4-159001-7.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • İlknur Yüksel-Kaptanoğlu
    • 1
    Email author
  • Ahmet Sinan Türkyılmaz
    • 1
  • İsmet Koç
    • 1
  1. 1.Institute of Population StudiesHacettepe UniversityAltindag AnkaraTurkey

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