Abstract
ObjectiveMaternal mortality reduction is a Millennium Development Goal. In Colombia, there is a large disparity in the maternal mortality ratio (MMR) between and into departments (states) and also between municipalities. We examined socioeconomics variables at the municipal and departmental levels which could be associated to the municipal maternal mortality in Colombia.MethodsA multilevel ecology study was carried out using different national data sources in Colombia. The outcome variable was the MMR at municipal level in 2011 with multidimensional poverty at municipal and department level as the principal independent variables and other measures of the social and economic characteristics at municipal and departmental level were also considered explicative variables (overall fertility municipal rate, percentage of local rural population, health insurance coverage, per capita territorial participation allocated to the health sector, transparency index and Gini coefficient). The association between MMR and socioeconomic contextual conditions at municipal and departmental level was assessed using a multilevel Poisson regression model.ResultsThe MMR in the Colombian municipalities was associated significantly with the multidimensional poverty (relative ratio of MMR: 3.52; CI 95%: 1.09-11.38). This association was stronger in municipalities from departments with the highest poverty (relative ratio of MMR: 7.14; CI 95%: 2.01-25.35). Additionally, the MMR at municipal level was marginally associated with municipally health insurance coverage (relative ratio of MMR: 0.99; CI 95%: 0.98-1.00), and significantly with transparency index at departmental level (relative ratio of MMR: 0.98; CI 95%: 0.97-0.99).ConclusionPoverty and transparency in a contextual level were associated with the increase of the municipal MMR in Colombia. The results of this study are useful evidence for informing the public policies discussion and formulation processes with a differential approach.
Highlights
Maternal mortality (MM) is a widely used indicator of health equality in a population, especially in issues related to gender and women’s health
Poverty and transparency in a contextual level were associated with the increase of the municipal maternal mortality ratio (MMR) in Colombia
A decrease has being shown in MMR since 1998, the ONS showed that this reduction is not enough to reach the goal of Millennium Development Goal (MDG)-5 for 2015 [6]
Summary
Maternal mortality (MM) is a widely used indicator of health equality in a population, especially in issues related to gender and women’s health. According to the World Health Organization (WHO), 287 thousands maternal deaths occurred worldwide in 2010 [1]. The WHO reported that countries in Latin America and the Caribbean had approximately 9,500 maternal deaths in the same year, for a maternal mortality ratio (MMR) of 88.9 per 100,000 live births [1]. Inequality in health care delivery has being hypothesized as an important factor related to the stagnation of MMR and lack of progress in the fifth Millennium Development Goal (MDG) in some countries [2,3]. According to the 2nd Report of the Colombian National Health Observatory (Observatorio Nacional de Salud—ONS), national MMR was 69.3 deaths per 100,000 live births in 2011. A decrease has being shown in MMR since 1998, the ONS showed that this reduction is not enough to reach the goal of MDG-5 for 2015 [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
