摘要：Objectives . We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods . Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged > 28 days and < 1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. Results . During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100 000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions . During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. Despite Latin America's overall declines in mortality and gains in life expectancy over the past few decades, inequity remains a leading health problem. 1 – 7 Data from the region on maternal, newborn, infant, and child health show better outcomes among women with higher socioeconomic status. 8 , 9 Available evidence on the coverage rates of maternal and child health initiatives similarly shows a regressive distribution of services, with the wealthiest groups disproportionately benefiting from the introduction of new programs. 2 , 10 – 13 Although maternal and child health inequities are prevalent throughout Latin America, their extent differs, with some countries making strides in their reduction in recent years. 8 Studies examining the success of some Latin American countries (e.g., Chile, Costa Rica, Cuba) in narrowing the gaps between the richest and poorest population groups attribute much of this success to improvements in women's access to education and increases in the coverage of public health measures. 2 , 3 , 14 – 16 Findings indicate that significant reductions in maternal and child health inequities in Latin American countries can be achieved under diverse political and economic conditions. Other countries in the region (e.g., Mexico, Colombia) have introduced health reforms to ensure that typically underserved groups are better targeted. 2 , 17 These efforts are further proof that maternal and child health inequities in Latin America are not immutable. Chile has been heralded for its achievements in improving maternal and child health. 3 , 7 We analyzed the declining trends in maternal and child mortality in Chile between 1990 and 2004 and the variances in mortality trends across district quintiles of socioeconomic status to determine whether and how these inequities changed. We explored reasons for the downward mortality trends and changes in the mortality differentials between district quintiles, such as national-level interventions and changes in key demographic indicators known to influence pregnancy outcomes. Our goal was to document Chile's declining maternal, newborn and child mortality trends during 1990 to 2004 and explore possible associations between these trends, health sector reforms, and improvements in the socioeconomic status of mothers. We expected to confirm overall declines in mortality and persistent inequities. Given the growing global interest in combating health disparities, our assessment of maternal and child mortality indicators in Chile—the first for this country—is an important first step toward identifying both coverage gaps across the continuum of care 18 and successful strategies in reducing inequities. Our findings may inform efforts in other countries to implement integrated maternal and children's health service packages and to achieve Millennium Development Goals 4 and 5 (reducing child mortality and improving maternal health, respectively). 19
