Urban-rural disparities in maternal mortality between 2014 and 2021 in Colombia

Introduction: Globally, approximately 800 pregnant women die each day. The incidence of this tragic event is influenced by various factors related to the environments in which individuals reside and interact. Consequently, residential locations might reflect systematic differences in exposures and vulnerabilities, impacting maternal mortality rates. In Colombia, maternal mortality has been on the rise. Yet, the patterns of this phenomenon and the extent of disparities among different social groups remain unclear. This study aimed to examine the trends in maternal mortality in Colombia and its social disparities based on the area of residence from 2014 to 2021. Methods: A longitudinal, ecological study was conducted using retrospective data obtained from vital statistics from the National Administrative Department of Statistics of Colombia. Using these data, the maternal mortality ratio was computed based on the deceased's residence area: municipal center, settlement, and remote rural area. Trend analysis was performed using joinpoint regression to estimate the annual percentage change (APC) and average annual percentage change. The slope index of inequality and relative index of inequality were also calculated to assess disparities in maternal mortality by area of residence. Results: Of the 3,260 identified deaths, 68.6% occurred in women residing in the municipal centers. In this group and in remote rural areas, mortality declined (APC= -2.55; 95% confidence interval (CI)= -10.32-5.89 and APC= -10.57; 95%CI= -17.18- -3.43, respectively). However, an increase was observed in 2019 for the municipal centers (APC=38.76; 95%CI=1.7-89.4) and in 2017 for remote rural areas (APC=12.21; 95%CI=7.26-17.38). Absolute disparities between areas ranged from 47 to 94 deaths, translating into relative differences of 41-88%. Conclusion: Maternal mortality rates have increased in recent years, with a more pronounced rise in remote rural areas than in settlements and municipal centers. Public health interventions should operate at multiple levels, incorporating territorial and cross-sectoral approaches, with resource allocation aimed at ensuring equitable healthcare access and implementing prevention strategies to reduce maternal mortality and social inequalities arising from the residential segregation observed between urban and rural areas.