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Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010

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  • David M Bishai
  • Robert Cohen
  • Y Natalia Alfonso
  • Taghreed Adam
  • Shyama Kuruvilla
  • Julian Schweitzer
Abstract
Introduction: From 1990–2010, worldwide child mortality declined by 43%, and maternal mortality declined by 40%. This paper compares two sources of progress: improvements in societal coverage of health determinants versus improvements in the impact of health determinants as a result of technical change. Methods: This paper decomposes the progress made by 146 low- and middle-income countries (LMICs) in lowering childhood and maternal mortality into one component due to better health determinants like literacy, income, and health coverage and a second component due to changes in the impact of these health determinants. Health determinants were selected from eight distinct health-impacting sectors. Health determinants were selected from eight distinct health-impacting sectors. Regression models are used to estimate impact size in 1990 and again in 2010. Changes in the levels of health determinants were measured using secondary data. Findings: The model shows that respectively 100% and 89% of the reductions in maternal and child mortality since 1990 were due to improvements in nationwide coverage of health determinants. The relative share of overall improvement attributable to any single determinant varies by country and by model specification. However, in aggregate, approximately 50% of the mortality reductions were due to improvements in the health sector, and the other 50% of the mortality reductions were due to gains outside the health sector. Conclusions: Overall, countries improved maternal and child health (MCH) from 1990 to 2010 mainly through improvements in the societal coverage of a broad array of health system, social, economic and environmental determinants of child health. These findings vindicate efforts by the global community to obtain such improvements, and align with the post-2015 development agenda that builds on the lessons from the MDGs and highlights the importance of promoting health and sustainable development in a more integrated manner across sectors.

Suggested Citation

  • David M Bishai & Robert Cohen & Y Natalia Alfonso & Taghreed Adam & Shyama Kuruvilla & Julian Schweitzer, 2016. "Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-13, January.
    • Handle: RePEc:plo:pone00:0144908
    DOI: 10.1371/journal.pone.0144908
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    References listed on IDEAS

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    1. Mohamed, Elwasila, 2018. "Bounds Test Cointegration Approach to Examine Factors Contributing to Declining Maternal Mortality Ratio in Sudan (1969-2015)," MPRA Paper 84952, University Library of Munich, Germany.
    2. Stierman, Elizabeth K. & Maliqi, Blerta & Mary, Meighan & Dohlsten, Martin AJ. & Katwan, Elizabeth & Moran, Allisyn C. & Creanga, Andreea A., 2023. "Changes in the health systems and policy environment for maternal and newborn health, 2008–2018: An analysis of data from 78 low-income and middle-income countries," Social Science & Medicine, Elsevier, vol. 321(C).
    3. Stephen Hall & Janine Illian & Innocent Makuta & Kyle McNabb & Stuart Murray & Bernadette AM O’Hare & Andre Python & Syed Haider Ali Zaidi & Naor Bar-Zeev, 2021. "Government Revenue and Child and Maternal Mortality," Open Economies Review, Springer, vol. 32(1), pages 213-229, February.
    4. Barnish, Maxwell S. & Tan, Si Ying & Robinson, Sophie & Taeihagh, Araz & Melendez-Torres, G.J., 2023. "A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes," Social Science & Medicine, Elsevier, vol. 339(C).
    5. Sabina Alkire & Usha Kanagaratnam & Ricardo Nogales & Nicolai Suppa, 2022. "Revising the Global Multidimensional Poverty Index: Empirical Insights and Robustness," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 68(S2), pages 347-384, December.
    6. Barbara Madaj & Helen Smith & Matthews Mathai & Nathalie Roos & Nynke van den Broek, 2017. "Developing global indicators for quality of maternal and newborn care: A feasibility assessment," WIDER Working Paper Series wp-2017-141, World Institute for Development Economic Research (UNU-WIDER).
    7. Emmanuel Banchani & Liam Swiss, 2019. "The impact of foreign aid on maternal mortality," WIDER Working Paper Series wp-2019-11, World Institute for Development Economic Research (UNU-WIDER).
    8. Perkiö, Mikko, 2021. "How does women’s education influence infant survival? A structural equation model using aggregate data from 95 low- and middle-income countries," International Journal of Educational Development, Elsevier, vol. 86(C).

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