Trends in maternal mortality in resident vs. migrant women in Shanghai, China, 2000-2009: a register-based analysis.

Although Shanghai has good maternal health indicators, it also has a large in-migrating population, which has made control of maternal mortality a major challenge. This study analyzed maternal mortality and causes of death in pregnant women in Shanghai in the ten years from 2000 to 2009, comparing resident and migrant women. All live births were registered and every maternal death audited. The number of live births rose from 84,898 in 2000 to 187,335 in 2009. The number of migrants increased 4.6 times, while the proportion of live births to migrant women increased from 27% to 55%. There were 262 maternal deaths, 55 in Shanghai residents and 207 in migrant women (78.9% of the total). Most deaths in migrant women were due to illegal delivery. Three policy changes focusing on maternal health greatly reduced deaths: low-cost delivery services were established for migrant women in maternity hospitals, five obstetric emergency care and referral centres were created in general hospitals, and training for health professionals and health education for women were instituted. Maternal mortality in Shanghai decreased steadily from 2000 to 2009, reaching 10 per 100,000 live births in 2009. Among Shanghai permanent residents the ratio was below ten in most of those years, while among migrant women it declined sharply from 58 to 12 per 100,000 live births.