The association between government healthcare spending and maternal mortality in the <scp>E</scp>uropean <scp>U</scp>nion, 1981–2010: a retrospective study

Maruthappu, Mahiben; Ng, Ka Ying Bonnie; Williams, Cheyenne; Atun, Rifat; Agrawal, Priya; Zeltner, Thomas

doi:10.1111/1471-0528.13205

Cited by 30 publications

(14 citation statements)

References 41 publications

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“…Only the public share of health expenditure showed an inverse relationship with MMRs in these rich countries. This finding is consistent with a recent study that revealed that reduction in government health-care spending led to increased MMRs in the European Union (Maruthappu et al, 2014). In the highincome group, the relationship between gender equality and female mortality has been suggested to be complicated.…”

Section: Discussionsupporting

confidence: 92%

“…The proportion of births attended by skilled health personnel is widely known as one of the most direct determinants of maternal mortality (Buor & Bream, 2004;Betrán, Wojdyla, Posner, & Gulmezoglu, 2005;WHO, 2014). This indicator was used as a covariate rather than a mediator in the pathway from the gender gap to the MMR in the existing studies (Shen & Williamson, 1999;Maruthappu et al, 2014), because substantial proportions of maternal deaths are attributed to illegal abortions, chronic malnutrition, and undertreated infections, all of which are associated with gender discrimination (Say et al, 2014). Public health expenditure was defined as the sum of spending from government budgets, external sources, and social or compulsory health insurance (World Bank, 2014).…”

Section: Methodsmentioning

confidence: 99%

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Gender gap matters in maternal mortality in low and lower-middle-income countries: A study of the global Gender Gap Index

Choe

Cho

Kim

2016

Global Public Health

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Reducing maternal mortality has been a crucial part of the global development agenda. According to modernisation theory, the effect of gender equality on maternal health may differ depending on a country's economic development status. We explored the correlation between the Global Gender Gap Index (GGI) provided by the World Economic Forum and the maternal mortality ratio (MMR) obtained from the World Development Indicators database of the World Bank. The relationships between each score in the GGI, including its four sub-indices (measuring gender gaps in economic participation, educational attainment, health and survival, and political empowerment), and the MMR were analysed. When the countries were stratified by gross national income per capita, the low and lower-middle-income countries had lower scores in the GGI, and lower scores in the economic participation, educational attainment, and political empowerment sub-indices than the high-income group. Among the four sub-indices, the educational attainment sub-index showed a significant inverse correlation with the MMR in low and lower-middle-income countries when controlling for the proportion of skilled birth attendance and public share of health expenditure. This finding suggests that strategic efforts to reduce the gender gap in educational attainment could lead to improvements in maternal health in low and lower-middle-income countries.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Gender gap matters in maternal mortality in low and lower-middle-income countries: A study of the global Gender Gap Index

Choe

Cho

Kim

2016

Global Public Health

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“…The relationship between government expenditure and MM has scarcely been studied owing mainly to the difficulty of identifying government expenditure on maternal health (GE) in a timely manner. While relevant literature indicates that such a relationship exists, its magnitude is as yet uncertain . In México, there is a dearth of literature dealing specifically with the relationship between maternal health indicators and the growth in public financial resources ensuing from the establishment of the SPSS.…”

Section: Introductionmentioning

confidence: 99%

“…While relevant literature indicates that such a relationship exists, 25 its magnitude is as yet uncertain. 9,26,27 In México, there is a dearth of literature dealing specifically with the relationship between maternal health indicators and the growth in public financial resources ensuing from the establishment of the SPSS. The one study published on the subject suggests an inverse association between government expenditure on health and the MM ratio.…”

Section: Introductionmentioning

confidence: 99%

Government expenditure on health and maternal mortality in México: A spatial‐econometric analysis

Pérez-Pérez

Serván‐Mori²,

Nigenda

et al. 2019

Health Planning & Management

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Summary Objective To assess the relationship between government expenditure on maternal health (GE) and maternal mortality (MM) in Mexican poor population between 2000 and 2015 in the 2457 Mexican municipalities. Methods Using administrative data, we performed the analysis in three stages: First, we tested the presence of selection bias in MM. Next, we assessed the presence of spatial dependence in the incidence and severity of MM. Finally, we estimated a spatial error model considering the correction of estimates for the spatial dependence and selection bias assessed before. Results MM and GE were not randomly distributed throughout the Mexican territory; the most socially vulnerable municipalities exhibited the highest levels of MM severity but the lowest levels of GE and available human and physical resources for maternal health; the incidence of MM was independent of GE; elasticity of GE‐severity in MM was −4% (P < 0.01). Conclusions Resource allocation for maternal health must move towards a more comprehensive vision, and efforts to achieve an effective delivery of universal health services must improve, particularly regarding the most vulnerable municipalities.

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“…Within the European Union (EU), the MMR in countries such as Hungary, Latvia and Romania is about 2e4 times higher than the EU average (estimated to be 8 maternal deaths per 100.000 live births in 2013) (WHO, 2014). A higher MMR not only indicates the more frequent occurrence of a tragic event but also suggests shortcomings in the maternal care system (Bouvier-Colle et al, 2012;Wildman et al, 2004;Maruthappu et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Barriers to accessing adequate maternal care in Central and Eastern European countries: A systematic literature review

Miteniece

Pavlova

Rechel

et al. 2017

Social Science & Medicine

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a b s t r a c tMaternal health outcomes in Central and Eastern Europe (CEE) compare unfavorable with those in Western Europe, despite macro-indicators that suggest well-designed maternal care systems. However, macro-indicators at the system level only capture capacity, funding and utilization of care and not the actual allocation of financial and human resources, the quality of care and access to it. It is these latter which are problematic in the CEE region. In this study service-related indicators of access to maternal care in CEE are examined. These include availability, appropriateness, affordability, approachability and acceptability of maternal care.This study uses a qualitative systematic literature review, analyzing information of peer-reviewed articles published since 2004. Other inclusion criteria included language, setting and publication purpose. The included articles were analyzed using a framework analysis technique and quality was assessed using standardized evaluation checklists.Results indicate improvements in maternal care. However, availability of care is limited by outdated equipment and training curricula, and the lack of professionals and pharmaceuticals. Geographical distance to healthcare institutions, inappropriate communication of providers and waiting times are the main approachability barriers. Some mothers are unaware of the importance of care or are discouraged to utilize healthcare services because of cultural aspects. Finally, a major barrier in accessing maternal care in the CEE is the inability to pay for it.Our findings indicate that major gaps in evidence exist and that more representative and better quality data should be collected. Governments in CEE countries need to establish a reliable system for measuring and monitoring a suitable set of indicators, as well as deal with the general social and economic problem of informality. Medical curricula in the CEE region need to be overhauled and there should be a focus on improving the allocation of medical staff and institutions as well as protecting vulnerable population groups to ensure universal access to care.

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The association between government healthcare spending and maternal mortality in the European Union, 1981–2010: a retrospective study

Cited by 30 publications

References 41 publications

Gender gap matters in maternal mortality in low and lower-middle-income countries: A study of the global Gender Gap Index

Gender gap matters in maternal mortality in low and lower-middle-income countries: A study of the global Gender Gap Index

Government expenditure on health and maternal mortality in México: A spatial‐econometric analysis

Barriers to accessing adequate maternal care in Central and Eastern European countries: A systematic literature review

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