Abstract
BackgroundThe aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs).MethodsTime series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957–2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques.ResultsDuring the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (−13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (−1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (−69.2%). The slope of the MMR did not appear to be altered by the change in abortion law.ConclusionIncreasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion.
Highlights
The fifth Millennium Development Goal (MDG) put forward by the United Nations (MDG-5) proposes to reduce the world’s maternal mortality ratio by 75%, by 2015 [1]
The findings of this study confirm that the maternal mortality ratio (MMR) in Chile has steadily and consistently decreased, reaching the lowest rate in Latin America and the second lowest rate in the American continent when the indirect estimates from the World Health Organization [35] are replaced by the official figures observed for Canada [43,44], Chile [45], United States [46,47], Costa Rica [48], Cuba [49], Argentina [50], Mexico [51,52] and Colombia [53,54] in 2008 (Figure 6; data calculation is presented in Table S7, Appendix S2)
Our analyses suggest that women’s education level and several other factors worked synergistically to explain the decrease in the MMR observed in Chile, during the rapid phase
Summary
The fifth Millennium Development Goal (MDG) put forward by the United Nations (MDG-5) proposes to reduce the world’s maternal mortality ratio by 75%, by 2015 [1]. Lowincome Latin American developing countries, such as El Salvador, Guatemala, Nicaragua, Ecuador, and Bolivia, have made substantial progress in reducing the MMR [3] Factors such as fertility rate [3,5,6,7,8,9] (a proxy for reproductive behaviour), per capita income [10] (an indicator of material resources in adult life), educational attainment of the female population [3,11,12,13,14,15] (an indicator of early life experiences, acquired knowledge and skills [16]), access to adequate maternal health facilities and personnel (e.g. skilled attendants) are all thought to be important determinants of maternal health [17,18,19,20,21]. The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations’ Millennium Development Goals (MDGs)
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