Abstract
BackgroundEl Salvador is recognized as a country that has effectively reduced its Maternal Mortality Ratio (MMR). While health indicators, such as total fertility rate, adolescent fertility rate, skilled birth attendance, and health expenditures, have improved in El Salvador, this improvement was unremarkable compared to advancements in other developing countries. How El Salvador could achieve an outstanding decrease in MMR despite unexceptional improvements in health and non-health indicators is a question that deserves deep research. We used quantitative methods and an observational case study to show that El Salvador could reduce its MMR more than expected by instituting health policies that not only aimed to reduce the (adolescent) fertility rate, but also provide safe birthing conditions and medical services to pregnant women through maternity waiting homes.MethodsWe ran pooled ordinary least squares regression and panel regression with fixed effects using MMR as the dependent variable and health and non-health factors as the independent variables. We conducted residual analysis, calculated the predicted value of MMR, and compared it with the observed value in El Salvador. To explain the change in MMR in El Salvador, we carried out an observational case study of maternity waiting homes in that country.ResultsEl Salvador could reduce MMR by improving health factors such as fertility rate skilled birth attendance and non-health factors, such as gross domestic product (GDP) per capita and female empowerment. However, even while considering these factors, the MMR of El Salvador decreased by more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is larger than expected from the regression results, can be attributed partly to government measures such as maternity waiting homes.ConclusionsThe reason for the unexplained reduction in El Salvador’s MMR seems to be attributed in part to health policies that not only aim to reduce the fertility rate but also to provide safe birthing conditions and medical services to pregnant women through maternity waiting homes.
Highlights
El Salvador is recognized as a country that has effectively reduced its Maternal Mortality Ratio (MMR)
We show that the case of El Salvador cannot be fully explained by the health and non-health indicators traditionally used in MMR analysis
It can be inferred that if the total fertility rate decreases by 1%, MMR would decrease by 0.97%
Summary
El Salvador is recognized as a country that has effectively reduced its Maternal Mortality Ratio (MMR) While health indicators, such as total fertility rate, adolescent fertility rate, skilled birth attendance, and health expenditures, have improved in El Salvador, this improvement was unremarkable compared to advancements in other developing countries. El Salvador is recognized as a country that has effectively reduced its maternal mortality ratio (MMR). The MMR in El Salvador decreased from 118 to 54 per 100,000 live births from 1995 to 2015, which was the largest reduction seen among comparable Latin American countries. The annual rate of MMR reduction in El Salvador was 5.2% between 1990 and 2015 [3]
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