Abstract
BackgroundMaternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women’s empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women’s advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-income countries, after controlling for other macro-level and direct determinants.MethodsUsing data from 44 low-income countries (half in Africa), we assessed the correlation of three composite measures – the Gender Gap Index, the Gender Equity Index (GEI), and the Social Institutions and Gender Index (SIGI) – with MMRs. We also examined two recognized contributors to reduce maternal mortality (skilled birth attendance (SBA) and total fertility rate (TFR)) as well as several economic and political variables (such as the Corruption Index) to see which tracked most closely with MMRs. We examined the countries altogether, and disaggregated by region. We then performed multivariate analysis to determine which measures were predictive.ResultsTwo gender measures (GEI and SIGI) and GDP per capita were significantly correlated with MMRs for all countries. For African countries, the SIGI, TFR, and Corruption Index were significant, whereas the GEI, SBA, and TFR were significant in non-African countries. After controlling for all measures, SBA emerged as a predictor of log MMR for non-African countries (β = –0.04, P = 0.01). However, for African countries, only the Corruption Index was a predictor (β = –0.04, P = 0.04). No gender measure was significant.ConclusionsIn African countries, corruption is undermining the quality of maternal care, the availability of critical drugs and equipment, and pregnant women’s motivation to deliver in a hospital setting. Improving gender equality and SBA rates is unlikely to reduce MMR in Africa unless corruption is addressed. In other regions, increasing SBA rates can be expected to lower MMRs.
Highlights
Maternal mortality has declined significantly since 1990
For Millennium Development Goals (MDGs) 5, countries pledged to attain a 75% reduction in their 1990 maternal mortality ratios (MMRs) by 2015
Among the three gender indices, Social Institutions and Gender Index (SIGI) was significantly worse in African countries compared to nonAfrican countries (P = 0.02), while there was no difference in Gender Equity Index (GEI) and Gender Gap Index (GGI)
Summary
Maternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women’s empowerment might be a contributing factor. Maternal mortality remains a major public health challenge worldwide. It is considered a social justice issue because women alone suffer from maternal deaths, most of these deaths could be prevented, and women of lower socioeconomic status are at much higher risk [1,2,3]. The global disparity is alarming – almost all maternal deaths (99%) occur in developing countries, more than half of which occur in sub-Saharan Africa [4]. To address this injustice, the international community agreed that improving maternal health would be one of the eight Millennium Development Goals (MDGs) adopted in 2000.
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