Program in Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America.
PLoS One. 2007 Aug 15;2(8):e750. doi: 10.1371/journal.pone.0000750.
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.
在墨西哥，女性死于产科原因的终生风险为 1/370，而在美国则为 1/2500。尽管过去十年国家已努力改善产科服务，但尚不清楚是否能实现千年发展目标 5——到 2015 年将孕产妇死亡率降低四分之三。
方法/主要发现：我们开发了一种经验校准模型，该模型模拟了 15 岁女性队列中妊娠及其相关并发症的自然病史，对其进行终生随访。在综合了孕产妇死亡率的国家和次国家趋势后，我们根据当前干预措施的具体覆盖范围对模型进行了校准，并通过将模型预测的预期寿命、总生育率、粗出生率和孕产妇死亡率与墨西哥特定数据进行比较来验证模型。我们使用已发表和原始数据评估了降低孕产妇发病率和死亡率的替代策略的比较健康和经济效益。增加 15%的计划生育覆盖率，并确保所有希望选择性终止妊娠的妇女都能获得安全堕胎，这种双重方法可使死亡率降低 43%，且与当前做法相比具有成本效益。最有效的策略增加了第三个组成部分，即至少为 90%需要转诊的妇女提供全面的紧急产科护理。在国家一级，该策略可将死亡率降低 75%，成本低于当前做法，增量成本效益比为每 DALY 300 美元，优于下一个最佳策略。在州一级进行的分析得出了类似的结果。
结论/意义：增加计划生育的提供和确保安全堕胎的机会是可行的、互补的和具有成本效益的策略，将在短期内提供最大的收益。在获得高质量的分娩和紧急产科护理方面的逐步改进将进一步降低孕产妇死亡和残疾。
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