Impact of relaxation of the one-child policy on maternal mortality in Guangzhou, China

Objective: To assess the impact of the one-child policy in China on maternal mortality. Methods: The present retrospective study included maternal death data from Guangdong, China, from January 1, 2006, to December 31, 2015; data from 2013 were excluded because they were not available. Maternal deaths were divided into legal and illegal pregnancies based on adherence to the one-child policy. The maternal mortality ratio (MMR) was compared between the groups, temporal trends in the MMR were examined, and comparisons were made of the causes of death and access to maternity care. Results: The final analysis included 847520 live deliveries and 383 maternal deaths. The MMR among legal pregnancies declined moderately from 18.5 deaths per 100000 live deliveries in 2006 to 12.2 deaths per 100000 live deliveries in 2015 (P=0.029), whereas the MMR among illegal pregnancies declined dramatically from 1268.4 deaths per 100000 live deliveries to 177.5 deaths per 100000 live deliveries (P<0.001). The proportion of avoidable maternal deaths decreased and access to quality maternity care improved among illegal pregnancies during the study period. Conclusions: Maternal mortality among illegal pregnancies declined with relaxation of the one-child policy in China.