Maternal health as a human right: health care system innovations to reduce inequities in maternal health in Bolivia, Nicaragua and Guatemala 1990-2018

In recognition of health as a human right, United Nations (UN) member countries vowed to reduce, by three-quarters, the 1990 maternal mortality ratio (MMR; maternal deaths per 100,000 live births) by 2015. To achieve this, countries implemented evidence-based maternal health interventions, with global impetus to focus on increasing the number of facility births, antenatal care and trained skilled birth attendants at birth. During the Millennium Development Goals (MDG 2000-2015) period, countries in Latin America and the Caribbean (LAC) made remarkable progress in reducing MMR, however, maternal deaths among the rural poor disproportionately constituted this rate. To close equity gaps, the Sustainable Development Goals (2015-2030, SDGs), implemented in 2016, aim to reduce maternal mortality to less than 70 maternal deaths per 100,000 live births (no country should have a MMR greater than 140 deaths/100,000 live births) by 2030, placing maternal health as a human right at the center of the goals. The public health significance of this paper is that no mother should die from preventable causes. This thesis is a comparative case study analysis with a desk review of outcome measures and literature to describe disparities in maternal health outcomes in Bolivia, Nicaragua and Guatemala. It captures policy and health system innovations to identify areas in which countries that have disparities in maternal mortality can improve. Cases are grouped based on their shared stage in the Obstetric Transition Theory and their high rates of inequitable access to health care and MMR. Despite the different country contexts, findings show that governments are successfully translating the language of health as a human right into tangible action, implementing health models for greater inclusion of vulnerable populations. In recognition of population health inequities, countries are investing in health care to achieve health as a human right. Evidence shows that country-led health models, inter-sectoral collaboration, and health financing are key to improving access to health care for vulnerable populations