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


RESULTS
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
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.
Hu
Delphine
D
Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America.
Bertozzi
Stefano M
SM
Gakidou
Emmanuela
E
Sweet
Steve
S
Goldie
Sue J
SJ
D000293:Adolescent; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics; D005193:Family Planning Services / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008427:Maternal Health Services / Q000191:economics*; D008428:Maternal Mortality / Q000639:trends*; D008800:Mexico; D018803:Models, Economic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics* / Q000628:therapy; D011256:Pregnancy Outcome / Q000191:economics*; D016896:Treatment Outcome
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