Abstract

Background: Since 1990, maternal mortality ratio (MMR) has significantly decreased in Iran. However, estimates for mortality and morbidity by cause at subnational scale are not available.Methods: This study is part of the Global Burden of Diseases study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 31 provinces of Iran from 1990 to 2019.Results: Since 1990, MMR declined from 44.5 (95 UI: 38.6-50.1) to 15.9 (14.7-17.3) per 100 000 live births in Iran. In 1990 MMR ranged from 18.5 (11.2-26.4) to 76.9 (38.4-114.7) per 100 000 live births across provinces. Respective figures for 2019 were 7.1 (5.2-9.3) to 34.0 (25.1-44.7) per 100 000 live births. In 2019, MMR was higher in young women (aged 10 to 14) and older women (aged 45 or more). Percentages of deaths under 25 years was 24.8 in 1990 and 16.0 in 2019. There was remarkable decline in years lost due to premature death (YLL) rates from 1990 to 2019. While the decline was modest for years lived with disability (YLD) rates. Indirect maternal deaths and other maternal deaths ranked first or second in almost all provinces. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic Index (SDI) from 1990 to 2019 in all provinces and an evident convergence across provinces.Conclusion: MMR has declined to levels much lower than Sustainable Development Goals in all provinces. Although there was a convergence in trends, there are still disparities across provinces. The decline in disabilities caused by maternal disorders is not as significant as mortality, which needs further actions.