Cause-specific mortality among women of reproductive age: Results from a population based study in an Iranian community

Women in the reproductive age, roughly from 15 to 49 years, comprise a vulnerable
group in most low- and middle-income countries as they are confronted with traditional
pregnancy-related complications besides the emerging challenges associated with noncommunicable diseases (NCDs) and injuries [1]. Due to the vital role played by women in the
family and society, unnatural deaths in women of reproductive age could have a major health
impact on both the family and community. In addition, all deaths among women of this age
group are premature, which occurs before age 70 [2]. Furthermore, there are substantial
inequalities in cause-specific mortality in this age group among countries. Consequently,
pregnancy-related complications account for the leading cause of death among women of
reproductive age in most resource-limited as well as most middle- and high-income countries.
The general pattern of adult female’s mortality has been associated with a progressive shift
towards a larger share of the deaths caused by NCDs and injuries [2].
Population-based data on mortality cause is an integral part of understanding health
and tailoring effective public health programs. Globally, few studies have investigated causespecific mortality in women of reproductive age [1, 3-8]. Investigations conducted in India
and Pakistan have shown that the high mortality rates (MRs) in these countries are linked to
the pregnancy-related complications. Apart from maternal mortality, neoplasia, infectious
diseases such as tuberculosis (TB), hepatitis and diarrhea, as well as cardiovascular diseases
and trauma were the main causes of reproductive age deaths [1, 5-8]. However, HIV/TB was
the leading causative agent of death among women of reproductive age in South Africa [4].
Despite a national vital registration system in Iran, underestimation of deaths in the
country has recently been documented [9]. Therefore, due to the lack of validated populationbased death registries in Iran, no detailed estimates are available to indicate cause-specific
mortality in women of reproductive age. There are also no research data from populationbased studies on female reproductive age mortality in Iran.
Application of the reproductive age mortality survey (RAMOS) method has been
suggested as a standard approach to increase the identification of deaths, as compared tohospital records and official government estimates in resource-limited countries [10].
Moreover, verbal autopsy (VA) has been indicated to be one of the best available techniques
for obtaining evidence on the causes of death in resource-limited areas [11]. However, this
method has not yet been used to estimate the completeness of the mortality registry in Iran.
This paper presents population-based information about the levels and causes of mortality
among women of reproductive age in Northwestern Iran, based on the data gathered from the
RAMOS. This is a pilot study of a larger survey that examines the true magnitude of maternal
mortality and cause-specific mortality using RAMOS and VA methodology in 11 selected
provinces in Iran.
Materials and Methods