Abstract
BackgroundReducing maternal mortality is a top priority in Latin American countries. Despite the progress in maternal mortality reduction, Brazil and Colombia still lag behind countries at similar levels of development.MethodsUsing data from the Demographic Health Survey, this study quantified and compared, by means of concentration indices, the socioeconomic-related inequity in access to four key maternal health interventions in Brazil and Colombia. Decomposition analysis of the concentration index was used for two indicators – skilled attendance at birth and postnatal care in Brazil.ResultsCoverage levels of the four key maternal health interventions were similar in the two countries. More specifically, we found that coverage of some of the interventions (e.g. ante-natal care and skilled birth assistance) was higher than 90% in both countries. Nevertheless, the concentration index analysis pointed to significant pro-rich inequities in access in all four key interventions in both countries. Interestingly, the analysis showed that Colombia fared slightly better than Brazil in terms of equity in access of the interventions studied. Finally, the decomposition analysis for the presence of a skilled attendant at birth and postnatal care in Brazil underlined the significance of regional disparities, wealth inequalities, inequalities in access to private hospitals, and inequalities in access to private health insurance.ConclusionsThere are persistent pro-rich inequities in access to four maternal health interventions in both Brazil and Colombia. The decomposition analysis conducted on Brazilian data suggests the existence of disparities in system capacity and quality of care between the private and the public health services, resulting in inequities of access to maternal health services.
Highlights
Reducing maternal mortality is a top priority in Latin American countries
Maternal deaths received a high level of global political attention for the first time in 2000, when United Nations member states pledged a reduction of 75% in the 1990 Maternal Mortality Ratio (MMR) by 2015 as part of their commitment to achieve eight Millennium Development Goals (MDG)
The new commitments set by the Sustainable Development Goals (SDG) in 2015 aim to build on the efforts that led to significant improvements in maternal health indicators
Summary
Despite the progress in maternal mortality reduction, Brazil and Colombia still lag behind countries at similar levels of development. Maternal deaths received a high level of global political attention for the first time in 2000, when United Nations member states pledged a reduction of 75% in the 1990 Maternal Mortality Ratio (MMR) by 2015 as part of their commitment to achieve eight Millennium Development Goals (MDG). SDG 3.1 sets a goal to decrease the global MMR to less than 70 per 100.000 live births by 2030. Despite these commitments, women continue to die owing to pregnancy-related causes — in lowto middle-income countries, and mostly during labour, delivery, or within 24 h postpartum [1]. As most of the maternal deaths occur in the poorest countries in the world (and among the poorer socioeconomic segments of the developed world), a higher MMR violates the principle
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