Education is the key factor in reducing maternal mortality according to a recently published analysis of 50 years of data from Chile’s National Institute of Statistics published in the online journal PLoS One. Between 1957 and 2007, the number of maternal deaths in Chile declined by a dramatic 93.8 %. In 1957, there were an average of 270.7 maternal deaths per 100,000 live births — in 2007, the number had fallen to 18.2.
Indeed, in 2008, the Maternal Mortality Ratio or MMR — which shows the number of maternal deaths arising from childbearing divided by the number of live births — fell even lower, to 16.5 per 100,000 live births. As a result, Chile is the country whose MMR is the second lowest in the American continent after Canada. Indeed, Chile’s MMR is a bit higher than that of the U.S.
Chile passed a severely restrictive abortion law in 1989 but the PLoS One study say this law was not the reason for the reduction in maternal deaths over the past 50 years.
Chile’s Abortion Law and Other Policies Affecting Maternal Health
To come to their conclusion, researchers looked at a number of factors that affect maternal mortality, including years of education, per capita income, total fertility rate, birth order, clean water supply, clean facilities, childbirth delivery by skilled attendants and nutrition for women and children in primary care clinics and schools. They also considered the effect of historical education and maternal health policies implemented in 1965 and the 1989 law that made abortion illegal in Chile. Notably, after 1989, the MMR continued to go down, from 41.3 to 12.7 per 100,000 live births, 69.2% reduction; as the study states, “the reduction in the MMR is not related to the legal status of abortion.” In comparison, the study authors note that European countries (Ireland, Malta and Poland) with the most restrictive abortion laws have some of the lowest MMRs in Europe.
With so many possible factors taken into account, the researchers found that the influence of education on improving maternal health was unquestionable. A law mandating free primary education up to a minimum of 8 years was implemented in 1965 in Chile. As a result, between 1957 and 2007, the average number of years that girls attended school increased rapidly from 3.1 to 12 years. Concurrently, women and children had more access to free preventive health services thanks to Chile’s growing public health primary care network, with services provided by physicians, nurses, professional midwifes and others. In addition, a school nutrition program that began in the 1950s became more widespread after 1965; all eligible school children now receive breakfast and lunch.
For every additional year of education a woman had, the researchers found a corresponding decrease in the MMR of 29.3 per 100,000 live births. As lead author and epidemiologist Dr. Elard Koch is quoted in Science Daily, “Educating women enhances women’s ability to access existing health care resources, including skilled attendants for childbirth, and directly leads to a reduction in her risk of dying during pregnancy and childbirth.”
There is one caveat, a “fertility paradox” found by the researchers. Even while education has helped to make Chile one of the safest places in the world for mothers, the rise in educated women has led to “decrease fertility, excessively delaying motherhood and puts mothers on risk because of their older age.” As Koch notes, a new problem “is not a question of how many children a mother has, but a question of when a mother has her children, specially the first of them.”
As the study notes, illegal or clandestine abortions are very likely ongoing in Chile. A 2007 study by B.L. Shepard and L. Casas Becerra, speculate that “[m]ore than 99% of induced abortions are not reported at all, disguised as a different procedure or reported as spontaneous abortion in public hospitals.” While the PLoS One study says that current epidemiological studies on abortion in Chilean hospitals do not support this, the effects of Chile’s abortion law still merit further study.
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