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Booklet: How to reduce maternal mortality in Mexico?

Based on a complete investigation published in BMJ Open, the researchers prepared a detailed report that presents to the general public the scientific evidence that identified the determinants of maternal mortality in each of the 32 Mexican states.


In the report, the reader will find 32 sheets with a ranking of maternal mortality in the 32 Mexican states, the most relevant determinants of maternal health identified in each one, and a set of specific recommendations for the design of public policies based on scientific evidence. Each Mexican state, in fact, presents its own challenges that require a policy that addresses maternal health determinants that differ from one state to another. It is recommended, before reviewing the fact sheet for a particular state, to read a brief glossary that describes the 7 determinants of maternal health found by the research.

The 7 determinants of maternal mortality identified in Mexico


Women's education: Studies invariably confirm that the lower the educational level of women of reproductive age is, the greater the risk of death during pregnancy, delivery and postpartum.  

Emergency obstetric care: This refers to the immediate care of an obstetric complication, such as hemorrhage, obstruction of labor, or a complicated abortion.

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Prenatal care and skilled attendance at birth: These factors refers to the number of women attending prenatal care early in their pregnancy and ultimately receiving skilled attendance at birth.

Clean water and sanitation: Among the environmental risk factors identified in the study of the 32 Mexican states, clean water and sanitation were clear determinants of maternal health. The lower the access to clean water and sanitation is, the greater the number of deaths during pregnancy.

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High-risk pregnancy and low birth weight: High-risk pregnancies, such as the one that occurs in malnourished women in the poorest regions, as well as the increase in pregnancies over 35 years of age in urban regions of Greater wealth, but with a higher population density, lower fertility and an aging population, present the highest rates of premature births and low birth weight.

Violence against women: Physical violence during pregnancy increases the risk of obstetric complications from beatings, injuries, premature labor and haemorrhage. Affected women often suffer barriers to accessing adequate prenatal care.


Fecundity and delayed motherhood: The increase in education levels, together with the greater participation of women in the labor force, have led to delayed motherhood and a decrease in fecundity. This phenomena have resulted in an increase in pregnancies at older ages, between 35 and 45 years. 


In the first section of each tab you will find an overview of the analyzed state, compared to the rest of the country. In this, we will find, first of all, the national mortality ratio, followed by a bar graph in which the 32 states are ordered by their RMM. On the other hand, in the lower section, we will see the main causes of maternal mortality in that state (induced abortion; spontaneous abortion; ectopic pregnancy, moles and others; sepsis; toxemia; hemorrhage; direct obstetric causes; other causes of maternal death) and what percentage of the state are attributable to each.


The second section presents the 7 determinants of maternal mortality, comparing the country situation against the state one.

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Finally, the last section proposes recommendations for the design of public health policies based on scientific evidence presented in the research “Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states”, published in BMJ Open. These recommendations seek to specifically address each determinant whose situation is below the national average.


This complete guide aims to become a tool when formulating public policies capable of specifically addressing all those variables capable of negatively impacting maternal health. The information contained in this report not only serves as an x-ray of all of Mexico, but also clearly indicates the present challenges and the steps to follow to save the lives of all women affected by the determinants presented in the published research. at BMJ Open.

We invite you to read this booklet at the following links:

Conference: Booklet presentation in Mexico

Presentación del informe sobre mortalidad materna en México.
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Presentation of the booklet "How to reduce maternal mortality in Mexico?" dictated by Dr. Elard Koch during his tour of Mexico.

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