Factors Affecting the Maternal Mortality in different Areas of Iran: A Systematic Review


1 Anesthesiologist, Department of Anesthesia, Faculty of Medicine, North Khorasan University of Medical Sciences, Shirvan, Iran.

2 Pediatrician, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant Professor of Intensive Care Medicine, Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Midwifery, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.

5 MSc of Biophysics, North Khorasan University of Medical Sciences, Bojnurd, Iran.

6 MSc of Midwifery, Shiraz University of Medical Science, Shiraz, Iran.



Background: Lowering the maternal death rate is the goal of many health organizations worldwide. The present study aimed to investigate the factors affecting maternal mortality ratio (MMR) in different regions of Iran.
Materials and Methods: In this systematic review, a systemic search of online databases (Medline, EMBASE, Scopus, Web of Science, Cochrane Library, CIVILICA, SID, Magiran, and Google Scholar search engine) was conducted for related studies with no time limit up to July 2022, using the related Mesh keywords. Two reviewers evaluated the quality of eligible studies and carried out the selection procedure.
Results: A total of 21 related studies were selected. The total maternal mortality rate for the studied period ranged from 15.8 (Tehran city) to 384 (Sistan and Baluchestan province) per 100.000 live births. According to the WHO, the MMR in Iran has decreased from 123 to 25 deaths per 100,000 live births between 1990 and 2018. The most common causes of death were bleeding (43.7%), preeclampsia/eclampsia (24.5%), hypertensive disorders (24%), and embolus (22.8%). There was a significant relationship between maternal deaths and pre-pregnancy care, disease during pregnancy, delivery type, maternal education level, maternal age, requiring special care, delivery agent, birth location, maternal socio-economic status, and the time between two pregnancies (p<0.05).
Conclusion: The results showed that maternal mortality rates varied from 15.8 to 384 per 100,000 live births. Although Iran has had a successful record in reducing the maternal mortality rate, there is still a recognizable disparity in MMR among provinces that should be addressed. The most common causes of maternal death were hemorrhage, preeclampsia/eclampsia, hypertensive disorders, and embolus.