2030 年降低美洲孕产妇死亡率的情景分析：从其速度中得到的启示。
Scenarios of maternal mortality reduction by 2030 in the Americas: insights from its tempo.
机构信息
Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, PAHO/WHO, Washington, DC, USA.
Latin American Center for Perinatology, Women's Health, and Reproductive Health (CLAP/WR), Pan American Health Organization, PAHO/WHO, Montevideo, Uruguay.
出版信息
Int J Equity Health. 2023 Jun 28;22(1):121. doi: 10.1186/s12939-023-01938-y.
BACKGROUND
The enduring threat of maternal mortality to health worldwide and in the Americas has been recognized in the global and regional agendas and their targets to 2030. To inform the direction and amount of effort needed to meet those targets, a set of equity-sensitive regional scenarios of maternal mortality ratio (MMR) reduction based on its tempo or speed of change from baseline year 2015 was developed.
METHODS
Regional scenarios by 2030 were defined according to: i) the MMR average annual rate of reduction (AARR) needed to meet the global (70 per 100,000) or regional (30 per 100,000) targets and, ii) the horizontal (proportional) or vertical (progressive) equity criterion applied to the cross-country AARR distribution (i.e., same speed to all countries or faster for those with higher baseline MMR). MMR average and inequality gaps -absolute (AIG), and relative (RIG)- were scenario outcomes.
RESULTS
At baseline, MMR was 59.2 per 100,000; AIG was 313.4 per 100,000 and RIG was 19.0 between countries with baseline MMR over twice the global target and those below the regional target. The AARR needed to meet the global and regional targets were -7.60% and -4.54%, respectively; baseline AARR was -1.55%. In the regional MMR target attainment scenario, applying horizontal equity would decrease AIG to 158.7 per 100,000 and RIG will remain invariant; applying vertical equity would decrease AIG to 130.9 per 100,000 and RIG would decrease to 13.5 by 2030.
CONCLUSION
The dual challenge of reducing maternal mortality and abating its inequalities will demand hefty efforts from countries of the Americas. This remains true to their collective 2030 MMR target while leaving no one behind. These efforts should be mainly directed towards significantly speeding up the tempo of the MMR reduction and applying sensible progressivity, targeting on groups and territories with higher MMR and greater social vulnerabilities, especially in a post-pandemic regional context.
背景
孕产妇死亡对全球和美洲健康的持久威胁已在全球和区域议程及其 2030 年目标中得到确认。为了为实现这些目标提供方向和所需努力的规模，根据从 2015 基准年开始的变化速度或变化速度，制定了一系列基于公平敏感性的孕产妇死亡率（MMR）降低区域情景。
方法
根据以下两项标准定义了 2030 年的区域情景：i）为实现全球（每 10 万人 70 例）或区域（每 10 万人 30 例）目标所需的 MMR 年均下降率（AARR），以及 ii）应用于国家间 AARR 分布的水平（比例）或垂直（渐进）公平标准（即，所有国家速度相同或基准 MMR 较高的国家速度更快）。MMR 平均值和不平等差距-绝对（AIG）和相对（RIG）-是情景结果。
结果
在基线时，MMR 为每 10 万人 59.2 例；AIG 为每 10 万人 313.4 例，RIG 为 19.0，其中基线 MMR 是全球目标两倍以上的国家与低于区域目标的国家之间的差距。为实现全球和区域目标所需的 AARR 分别为-7.60%和-4.54%，而基线 AARR 为-1.55%。在实现区域 MMR 目标的情景中，应用水平公平性将使 AIG 降低至每 10 万人 158.7 例，RIG 将保持不变；应用垂直公平性将使 AIG 降低至每 10 万人 130.9 例，RIG 将在 2030 年降低至 13.5。
结论
减少孕产妇死亡和减少其不平等的双重挑战将要求美洲国家做出巨大努力。这对于他们的集体 2030 年 MMR 目标仍然是正确的，而不会让任何人掉队。这些努力应主要集中在显著加快 MMR 降低的速度，并应用合理的渐进性，针对死亡率较高和社会脆弱性较大的群体和地区，特别是在后疫情时代的区域背景下。
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