Impact of maternal mortality as a health indicator in the DR

Dr. Randol Manuel Cabrera. Epidemiologist, Manager of the Epidemiology, Statistics and Information Analysis Unit of the General Hospital Plaza de la Salud.

One of the goals of the Millennium Development Goals (MDGs) was to reduce maternal mortality by three quarters (75 %), between 1990 and 2015, however, the maternal mortality rate has been reduced by almost half (45 %) and most of this reduction has occurred since 2000 (37 %).

So to ensure the achievement of this goal as part of a new agenda, the Sustainable Development Goals were established.

Latin America and the Caribbean have a low maternal mortality ratio (MMR) (85) and experienced a decrease of 40 % between 1990 and 2013. The Latin American countries that made the least progress in reducing the MMR were Barbados (-56 %) , Bolivia (-61%), Brazil (-43 %), Ecuador (-44 %), El Salvador (-39 %), Guatemala (-49 %), Haiti (-43 %), Honduras (-61 %), Nicaragua (-38 %), Peru (-64 %) and the Dominican Republic, with -57 %.

Several of these countries had the highest mortality rates in the region in 1990. Between 2005 and 2013, the reduction was just 1.1 %, so that no country in the region was able to achieve the Development Objective of the Millennium (MDG) 1.

In this context, the action plan for the reduction of maternal mortality and extreme maternal morbidity (MME) of the World Health Organization / Pan American Health Organization (WHO / PAHO) has the general objectives of: a) contributing to accelerate the reduction of maternal mortality, b) prevent severe maternal morbidity, and c) strengthen surveillance of maternal morbidity and mortality.

The frequency of the MME is higher for low- and middle-income countries; It ranges from 4.93 % in Latin America to 5.07 % in Asia and 14,98% in Africa, while studies in high-income countries had rates ranging from 0.79 % in Europe and a maximum of 1.38 % in North America.

The Dominican Republic ranks fifth in pregnancies for girls and adolescents among Latin American and Caribbean countries.

According to the National Survey of Multiple Purpose Homes (Enhogar 2009), 22 % of adolescents between 15 and 19 years old in the country have had at least one pregnancy.

The highest rates are observed in the provinces of Azua (36.9 %) and Pedernales (35.1 %).

The country has the adequate legislative and political framework to prevent adolescent pregnancy, however, the lack of sexual and reproductive health education and services programs are an obstacle to reducing the high rate that occurs at the national level.

Clinical features. Maternal morbidity is the injury or disability that occurs during pregnancy, childbirth, or within 42 days after delivery (postpartum), either acute, chronic, or both.

The changes in the physiology of the pregnant woman when faced with a harmful agent are part of a continuous process that starts from normal pregnancy and moves towards increasingly serious morbidity events until death.