title: Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: David M
authors.initials: DM
authors.lastname: Bishai
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Y Natalia
authors.initials: YN
authors.lastname: Alfonso
authors.affiliation: World Health Organization, Health Systems and Innovation, Geneva, Switzerland.
authors.forename: Taghreed
authors.initials: T
authors.lastname: Adam
authors.affiliation: World Health Organization, Family, Women's and Children's Health, Geneva, Switzerland.
authors.forename: Shyama
authors.initials: S
authors.lastname: Kuruvilla
authors.affiliation: Results for Development, Washington, District of Columbia, United States of America.
authors.forename: Julian
authors.initials: J
authors.lastname: Schweitzer
mesh_terms: D002648:Child; D000067576:Child Health / Q000266:history / Q000706:statistics & numerical data* / Q000639:trends; D046688:Child Mortality / Q000266:history / Q000639:trends; D003906:Developing Countries; D015981:Epidemiologic Factors; D005260:Female; D014943:Global Health; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D000068097:Maternal Health / Q000266:history / Q000706:statistics & numerical data* / Q000639:trends; D008428:Maternal Mortality / Q000266:history / Q000639:trends; D012959:Socioeconomic Factors