Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013

Lamadrid‐Figueroa, Héctor; Montoya, Alejandra; Fritz, Jimena; Olvera, Marisela; Torres, Luis Manuel; Lozano, Rafael

doi:10.1371/journal.pone.0157495

Cited by 13 publications

(11 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Maternal mortality surveillance studies such as confidential enquiry have showed that late maternal death is non-trivial in even low-resource settings34,59 and can account for up to 40% of maternal deaths in high-income settings 60. A contemporary linkage study in Mexico found that 18% of maternal deaths are missed when the definition is truncated at 42 days’ post partum 61. As immediate mortality continues to decrease as a result of improved antenatal, obstetric, and post-partum care, it is therefore increasingly likely that the proportion of late maternal deaths will continue to increase.…”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Kassebaum¹,

Barber²,

Bhutta³

et al. 2016

The Lancet

Self Cite

844

469

View full text Add to dashboard Cite

Summary Background In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. Methods We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10–54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Findings Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. Interpretation Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care—including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum r...

show abstract

Section: Discussionmentioning

confidence: 99%

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Kassebaum¹,

Barber²,

Bhutta³

et al. 2016

The Lancet

Self Cite

844

469

View full text Add to dashboard Cite

show abstract

“…Following previous studies, we calculated the annual municipal MM ratio and according to place of residence. Estimates were obtained by dividing the number of women (between ages 10 and 49) without social security coverage who died as a result of gestation by the number of live births.…”

Section: Methodsmentioning

confidence: 99%

“…Following previous studies, 23,33 we calculated the annual municipal MM ratio and according to place of residence.…”

Section: Analytical Variablesmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…As reflected in CONEVAL reports, poverty and inequality prevail in Mexico. In 2014, 46.2% of the Mexican population was in poverty and 9.5% in extreme poverty, states such as Chiapas, Estado de Mexico, Veracruz, Guerrero, Oaxaca and Puebla represent around 60% of the population in poverty and extreme poverty [ 8 ]. There is a direct correlation between MMR and poverty indicators.…”

Section: Resultsmentioning

confidence: 99%

“…The programs implemented to date in Mexico have had positive effects but have not been sufficient to reduce maternal mortality, especially if the indicators of maternal mortality in vulnerable population are analyzed. In Mexico, 46.2% of its population live in poverty and 9.5% in extreme poverty, a component that defines this poverty level is the lack of access to health services [ 8 ]. This population is the one that shows higher levels in maternal mortality indicators, there is currently no program focused on reducing maternal mortality in vulnerable population.…”

Section: Introductionmentioning

confidence: 99%

Maternal mortality in Mexico, beyond millennial development objectives: An age-period-cohort model

Rodríguez-Aguilar

2018

PLoS ONE

View full text Add to dashboard Cite

The maternal mortality situation is analyzed in México as an indicator that reflects the social development level of the country and was one of the millennial development objectives. The effect of a maternal death in the related social group has multiplier effects, since it involves family dislocation, economic impact and disruption of the orphans' normal social development. Two perspectives that causes of maternal mortality were analyzed, on one hand, their relationship with social determinants and on the other, factors directly related to the health system. Evidence shows that comparing populations based on group of selected variables according to social conditions and health care access, statistically significant differences prevail according to education and marginalization levels, and access to medical care. In addition, the Age-Period-Cohort model raised, shows significant progress in terms of a downward trend in maternal mortality in a generational level. Those women born before 1980 had a greater probability of maternal death in relation to recent generations, which is a reflection of the improvement in social determinants and in the Health System. The age effect shows a problem in maternal mortality in women under 15 years old, so teen pregnancy is a priority in health and must be addressed in short term. There is no clear evidence of a period effect.

show abstract

Towards an Inclusive and Evidence-Based Definition of the Maternal Mortality Ratio: An Analysis of the Distribution of Time after Delivery of Maternal Deaths in Mexico, 2010-2013

Cited by 13 publications

References 21 publications

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

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

Maternal mortality in Mexico, beyond millennial development objectives: An age-period-cohort model

Contact Info

Product

Resources

About