Background: Lowering the maternal death rate is a goal for many health organizations worldwide. The present study aimed to investigate the factors affecting the maternal mortality ratio (MMR) in different regions of Iran.
Materials and Methods: For this systematic review, we conducted a comprehensive search of online databases (MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, CIVILICA, SID, Magiran, and Google Scholar) for relevant studies published up to July 2022, using appropriate MeSH keywords. Two reviewers independently assessed the quality and selected the studies.
Results: A total of 21 relevant studies were selected. The maternal mortality rate (MMR) during the study period ranged from 15.8 per 100,000 live births in Tehran to 384 per 100,000 live births in Sistan and Baluchestan province. According to the World Health Organization (WHO), the MMR in Iran decreased from 123 to 25 deaths per 100,000 live births between 1990 and 2018. The leading causes of maternal death were hemorrhage (43.7%), preeclampsia/eclampsia (24.5%), other hypertensive disorders (24%), and embolism (22.8%). A significant association was found between maternal mortality and pre-pregnancy care, pregnancy-related diseases, mode of delivery, maternal education level, maternal age, and the need for specialized care, birth attendant, delivery location, maternal socioeconomic status, and interpregnancy interval (p < 0.05).
Conclusion: While Iran has made significant progress in reducing maternal mortality, rates varied considerably across provinces, ranging from 15.8 to 384 per 100,000 live births. This disparity warrants further attention. Hemorrhage, pre-eclampsia/eclampsia, hypertensive disorders, and embolism were the most common causes of maternal death.