Maternal deaths among women with pregnancies outside of family planning in Sichuan, China.

To assess the impact of family planning status on maternal mortality, we analyzed data gathered in a community-based, maternal mortality surveillance study conducted by the Sichuan Health Department in the People's Republic of China during 1989-1991. The overall maternal mortality ratio, which included only deaths of pregnant women within family planning guidelines ("planned" pregnancies), was 78.9 per 100,000 livebirths. When the deaths of pregnant women outside of family planning ("unplanned" pregnancies) were included, the maternal mortality ratio doubled to 135.6 per 100,000 livebirths. The leading causes of death for women with "planned" and "unplanned" pregnancies were the same: hemorrhage, postpartum infection, pregnancy-induced hypertension, cardiac diseases, and pulmonary diseases. As among women with "planned" pregnancies, about 40% of maternal deaths among women with "unplanned" pregnancies occurred at home, and 20% occurred en route to a hospital. After controlling for the confounding effects of gravidity and education, the odds ratio of maternal death associated with "unplanned" pregnancy status was 2.6 [95% confidence interval (CI) = 2.0-3.7], which declined to 2.0 (95% CI = 1.4-2.9) with additional control for the effect of prenatal care visits. Our study indicates that women with "unplanned" pregnancies have a higher risk of maternal death, which is only partially attributed to less prenatal care.