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The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico.


ABSTRACT:

Background

In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met.

Methodology/principal findings

We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results.

Conclusions/significance

Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency obstetric care will further reduce maternal deaths and disability.

SUBMITTER: Hu D 

PROVIDER: S-EPMC1939734 | biostudies-literature | 2007 Aug

REPOSITORIES: biostudies-literature

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Publications

The costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico.

Hu Delphine D   Bertozzi Stefano M SM   Gakidou Emmanuela E   Sweet Steve S   Goldie Sue J SJ  

PloS one 20070815 8


<h4>Background</h4>In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5--to reduce maternal mortality by three-quarters by 2015--will be met.<h4>Methodology/principal findings</h4>We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications i  ...[more]

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