Trends in maternal mortality ratio among women of German and non-German nationality in West Germany, 1980-1996

Background Maternal mortality is a sensitive indicator for inequity in heal th. We describe recent trends in overall and cause-specific maternal mortal ity ratio among women of German and non-German nationality residing in West Germany. Methods Using birth and death register data for 1980-1996 we related 1067 c ases of maternal death (ICD 9: 630-676) to 11.2 million live births. We ass essed the effects of nationality and of marital status, a proxy for socioec onomic status, controlling for year of death and age of the mother in a Poi sson regression model. Results Maternal mortality ratio in West Germany decreased from 13 per 1000 00 live births in 1980-1988 to 6.1 in 1989-1996. The crude relative risk fo r non-German nationality decreased from 1.9 (95% CI : 1.6-2.3) to 1.3 (1.0- 1.7); after adjusting for age, year of death and marital status it was 1.7 (95% CI: 1.4-2.1) and 1.6 (95% CI: 1.2-2.1). Unmarried women incurred an ad justed relative risk of 1.8 (95% CI: 1.5-2.3). Non-German women experienced an excess mortality from abortions which largely disappeared in 1989-1996; concurrently, being unmarried no longer conveyed an additional risk to the m. The risk status of German mothers developed unfavourably: increasing pro portions are unmarried, which continues to be a marker of elevated relative risk in this group. Conclusions Our findings suggest continuously improving accessibility and q uality of obstetric services, in particular for women of non-German nationa lity. Still, inequity in maternal risk continues to exist. Maternal risk, h owever, is not determined by the simple distinction 'German' versus 'non-Ge rman'; its association with socioeconomic status extends beyond nationality .