Maternal mortality rates for Indigenous and Afro/Colombian groups in Colombia: an ecological study

High rates of maternal mortality continue to be one of the most important public-health issues in Colombia. In 2020 the total mortality rate for the country was 102 per 100,000 live newborns, one of the highest in Latin America. Indigenous and Afro-Colombian women present some of the highest maternal mortality rates in the country. However, there is limited evidence available for an analysis of how much maternal mortality varies between municipalities, depending on the percentage of Indigenous and Afro-Colombian populations. This article analyses whether the proportion of Indigenous and Afro-Colombian populations at the municipality level (admin level 3) is associated with high levels of maternal mortality rates in Colombia between 2017 and 2020. For an ecological study in which the observation units were the 1,122 Colombian municipalities, we used data from the Departamento Administrativo Nacional (DANE), the Ministry of Health and Social Protection (MinSalud), the Departamento Nacional de Planeación (DNP), and Terridata between 2017 and 2020. We estimated a multivariate generalised Poisson robust linear regression model, inflated by zeros, to analyse whether the percentage of people from different ethnic backgrounds was a determinant of maternal mortality at the municipality level and across time. Maternal mortality rates increased between 2017 and 2020, and the increase was concentrated in municipalities in remote areas of the country, such as Vaupés, Guainía, and La Guajira. The results revealed that municipalities with a higher proportion of Indigenous and Afro-Colombian populations have higher probabilities of presenting high rates of maternal mortality, and when these populations are living in rural areas, maternal mortality increases even more.