Reducing Maternal Mortality by Fighting Corruption
Maternal mortality, the death of women during or following pregnancy and childbirth, is declining, but at one third of the speed necessary to reach the Sustainable Development Goal of 70 maternal deaths per 100,000 live births by 2030. According to the World Health Organization, in 2020, ca. 287,000 deaths were recorded, 95% of them in low and lower middle-income countries, and around two-thirds in Sub-Saharan Africa.
The actions usually recommended to reduce maternal mortality are health system improvements to guarantee access to quality care, and women's empowerment to promote their ability to make strategic life choices, including the use of modern contraception. A new paper suggests that reducing corruption could also play a significant role.
Authored by four scholars affiliated to the Bocconi's Dondena Centre for Research on Social Dynamics and Public Policy (Arnstein Aassve, Alexandros Kentikelenis, Letizia Mencarini, and Veronica Toffolutti – the latter also affiliated to the Queen Mary University of London) and Eugenio Paglino (a Bocconi alumnus, now at the University of Pennsylvania), and published on PLOS Global Public Health, the paper is based on individual and regional data from 135 regions in 17 Sub-Saharan African countries over the period 2002–2018.
The authors got their measurement of maternal mortality from the Development and Health Surveys and their measurement of corruption (calculated as the percentage of people who reported having paid for a bribe, given a gift, or done a favor to police officers or governmental officials in last 12 months) from the Afrobarometer surveys. After harmonizing the two sources, they were left with data about more than 470 thousand pregnancies.
Data show that 8.6 out of 1,000 pregnancies resulted in a pregnancy-related death in the period under examination (for a total of more than four thousand deaths in the sample). However, this aggregate figure masks country-specific variations: the rate varies between 2.1‰ in Togo and 17.5‰ in Lesotho.
As for corruption, 30.7% of the respondents had first-hand experience of bribery, with Kenya ranking at the top of this bribery index with an average of 46.9% and South Africa at the bottom with an average of 9.1%.
The authors found that an increase of 10 percentage points in the prevalence of bribery is associated with a 4% increase in pregnancy related deaths (41 additional deaths for every 1,000 pregnancy-related deaths).
The authors also found that women living in areas with higher levels of educational attainment are less likely to die during pregnancy or within two months of birth, and that healthcare quality-proxied by the attendance of skilled health personnel during delivery/termination and prenatal care during pregnancy-significantly reduces maternal mortality. Corruption, though, erodes the advantage of healthcare quality: as bribery becomes more common, the maternal mortality gap between high- and low-quality healthcare systems becomes thinner.
Toffolutti V, Paglino E, Kentikelenis A, Mencarini L, Aassve A (2023) "Does Bribery Increase Maternal Mortality? Evidence from 135 Sub-Saharan African Regions." PLOS Glob Public Health 3(12): e0000847. DOI: https://doi.org/10.1371/journal.pgph.0000847.