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dc.contributor.authorHu, Delphine
dc.contributor.authorBertozzi, Stefano M.
dc.contributor.authorGakidou, Emmanuela
dc.contributor.authorHoffman, Daniel
dc.contributor.authorSweet, Steven Goldie
dc.contributor.authorGoldie, Sue J.
dc.date.accessioned2010-11-18T14:26:03Z
dc.date.issued2007
dc.identifier.citationHu, Delphine, Stefano M. Bertozzi, Emmanuela Gakidou, Steve Sweet, and Sue J. Goldie. 2007. The Costs, benefits, and cost-effectiveness of interventions to reduce maternal morbidity and mortality in Mexico. PLoS ONE 2(8).en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:4578394
dc.description.abstractBackground: 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.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0000750en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1939734/pdf/en_US
dash.licenseLAA
dc.subjectwomen's healthen_US
dc.subjectpublic health and epidemiologyen_US
dc.subjectobstetricsen_US
dc.subjectevidence-based healthcareen_US
dc.titleThe Costs, Benefits, and Cost-Effectiveness of Interventions to Reduce Maternal Morbidity and Mortality in Mexicoen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorGoldie, Sue J.
dc.date.available2010-11-18T14:26:03Z
dash.affiliation.otherSPH^Health Policy and Managementen_US
dc.identifier.doi10.1371/journal.pone.0000750*
dash.authorsorderedfalse
dash.contributor.affiliatedSweet, Steven
dash.contributor.affiliatedGoldie, Sue


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