Objective  To examine levels and changing trend of maternal mortality in different regions of the world from 1980 to 2015 and in China from 1990 to 2014 and to provide evidences for developing intervention strategies by governmental agencies.

  Methods  We collected data on maternal mortality and cause-specific mortality in different geographical regions, sub-regions and countries of the world, as well as in different provinces and cities of China, in different years from publications of World Health Organization (WHO), United Nations International Children′s Emergency Fund (UNICEF), and United Nations Fund for Population Activities (UNFPA) and then established a dataset for the data using SPSS 15.0. We conducted hierarchical clustering analysis on the data of 31 provinces, autonomous regions, and municipalities of China during different periods.

  Results  The maternal mortality rate dropped by 52.0% over the 35-year period in all countries and regions in the world and the decline was less than the three-quarters reduction of the Millennium Development Goals. In South Asia, East Asia/Pacific and Central/Eastern Europe, the maternal mortality rate dropped significantly by 70% or above, meaning that the Millennium Development Goals have been achieved. Of all the maternal deaths during 2015 in the world, more than 80% occurred in Western/Central African countries (28.2%), the least developed countries (18.0%), East/South Africa (17.2%), and sub-Saharan Africa (17.2%). In 2015, the lifetime risk ratio of death for women in pregnancy and childbirth was below 1 : 52 in Africa and the least developed countries but the ratio was 1 : 2000 in developed countries. In China, the maternal mortality rate dropped from 94.7/100 000 in 1990 to 21.7/100 000 in 2014, with a decline of 77.1% reaching the Millennium Development Goals, and the reduction ratio was higher in rural areas (80.7%) than in urban areas (58.9%) during the 25-year period; in 2013, the maternal mortality rate was 22.4/100 000 in urban areas and 23.6/100 000 in rural areas, with a gradually narrowed urban-rural gap.

  Conclusions  In China, there are still urban-rural, regional, and population disparity in maternal mortality rate and the mortality rate is higher in rural areas, western regions than in urban areas and eastern regions and higher among migrant populations than among resident populations. The results suggest that special attentions should be paid to maternal health in rural areas, western regions, and among migrant populations.