Figure 1.
Trend for maternal mortality ratio, Chile 1957–2007.
The secondary graphic shows the best adjustment of total trend for Maternal Mortality Ratio (MMR) over time.
Figure 2.
Relative importance of different causes of maternal death in four periods in Chile between 1957 and 2007.
Pie chart A represents the period from 1958 to 1962; B period from 1971 to 1075; C period from 1985 to 1989; and D period from 2003 to 2007. Each period shows the five major causes of maternal mortality according to international codes of disease. Code homologation was carried out using ICD 7th version (ICD-7) as reference. Causes of death present in ICD versions 8, 9 and 10 were grouped using ICD-7 codes A115 (Sepsis); A116 (Hypertension, Eclampsia and Toxaemias); A117 (Haemorrhage); A118 and A119 (Abortion); A120 (Other direct and indirect obstetric causes of death, including ectopic pregnancy, hydatidiform mole and other abnormal products of conceptions). Pie charts C and D include a more specific subgroup for death causes from ICD-9 and ICD-10.
Figure 3.
Trend for abortion mortality ratio (AMR), Chile 1957–2007.
The highest AMR was observed in 1961, with 95.1 per 100,000 live births decreasing to 0.83 per 100,000 live births in 2007. This represented an accumulated reduction of 99.1%. The best estimated curve for the total trend over time was exponential with a goodness-of-fit of 93.5% (secondary chart). In 1989, the year of abortion prohibition, AMR was 10.78 per 100,000 live births. The accumulated decrease for the period between 1989 and 2007 was −9.95 per 100,000 live births (a reduction of 92.3% from 1989).
Table 1.
Parallel time series of the co-variables assessed in the study on maternal mortality in Chile from 1957 to 2007.
Figure 4.
Correlations between parallel time series of maternal mortality ratio and different determinants, Chile 1957–2007.
A strong (R2>90) inverse correlation can be observed in charts A, C, E, G y H and a direct correlation can be observed in chart B (Total Fertility Rate). Correlations were slightly lower for charts D and F, both showing an inverse relationship.
Figure 5.
Slopes of different segments observed in the trend of the maternal mortality ratio between 1957 and 2007.
The slopes for the periods 1981 to 2003 and 1989 to 2003 were parallel and no statistical difference was detected in β-coefficients.
Table 2.
Segmented regression models assessing different join points in the time series of the maternal mortality ratio from 1957 to 2007 in Chile.
Table 3.
Pathway modelling using autoregressive integrated moving average (ARIMA) models for assessing the different predictors of the maternal mortality ratio in a time series from 1957 to 2007 in Chile.
Figure 6.
Ranking of maternal mortality ratios (MMR) in the American continent for 2008.
Official MMR for Chile [45] is compared to official World Health Organization (WHO) estimates [35] on other American countries, except for those with asterisks. *Official domestic data for Canada [43], [44], Chile [45], United States [46], [47], Costa Rica [48], Cuba [49], Argentina [50], Mexico [51], [52] and Colombia [53], [54]. An important overestimation for these countries is observed when comparing WHO estimates to official domestic data. For instance, according to official data available for the U.S., 795 maternal deaths [47] and 4,247,694 live births [46] occurred in 2008. In consequence, the MMR for the U.S. that year was 18.7 per 100,000 live births. For Chile, the MMR was 16.5 per 100,000 live births (41 maternal deaths and 248,366 live births [45]). The same figure, but using indirect estimates for MMR reported by WHO [35] was 24 per 100,000 live births for the U.S. and 26 per 100,000 live births for Chile. In consequence, there is an overestimation of 28.3% for the U.S. and 57.6% for Chile in the WHO report. ** Data extracted from the study by Hogan et al. [3]