Abstract
Abstract. Unlike other studies in the field of maternal health, the objective of this study is to examine the contribution of some socioeconomic, demographic and health care factors to the declining trend of maternal mortality ratio MMR in Sudan over the period 1969-2015. The study employs econometric techniques including the OLS, cointegration methods of Johansen and autoregressive distributed lag ARDL bounds tests and Granger causality analysis. The OLS shows that economic growth measured by GDP has significant bad affect on MRR but it has more significant good effect when measured by GDP per capita GDPP. Declining fertility rates lead to declines in MMR. Health expenditure has no effect on MMR. The ARDL bounds test shows existence of a long-run equilibrium relationship between MMR and its explanatory variables. In both the short run and long run, declines in MMR are explained by GDPP and fertility but badly affected by GDP. In contrast, health care factors have no effects on MMR. Granger causality test shows a unidirectional relationship running from economic growth measured by GDP and GDPP to MMR with no sign of feedback effect. Bidirectional relationships between MMR and fertility rate, MMR and health expenditure, as well as between MMR and the number of physicians per 100,000 people have been established. The study recommends that the government should ensure stable and inclusive economic growth. There is a need to increase resources to maternal and reproductive health with emphasis on the number of physicians per 100,000 people in order to move forward to the SDGs.
Keywords. Maternal mortality, GDP, Fertility, Health care, Cointegration, ARDL, Sudan.
JEL. C13, C32, C51, H51, I15.
References
Alkema, L., Chou, D., Hogan, D., Zhang, S., Moller, A.B., Gemmill, A., Ma Fat, D.,. Boerma, D., Temmerman, M., Mathers, C., & Say., L. (2015). Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: A systematic analysis by the UN maternal mortality estimation inter-agency group, The Lancet, doi. 10.1016/S0140-6736(15)00838-7
Alvarez, J.L., Gil, R., Hernandez, V., Gil, A. (2009). Factors associated with maternal mortality in Sub-Saharan Africa: an ecological study, BMC Public Health, 9, 462. doi. 10.1186/1471-2458-9-462
Awad, M.H. (1992). The Sudan and the IMF, (DSRC Book Series), University of Khartoum Press.
Barro, R.J. (1996). Health, Human Capital and Economic Growth, Paper for the Program on Public Policy and Health, Pan American Health Organization and World Health Organization, Washington: Pan American Health Organization.
Barro, R.J. (2013). Health and Economic Growth, Annals of Economics and Finance, 14(1), 305-342.
Bishai, D.M., Cohen. R., Alfonso, Y.N., Adam T., Kuruvilla, S., & Schweitzer, J. (2016). Factors contributing to maternal and child mortality reductions in 146 low- and middle-income countries between 1990 and 2010. PLoS ONE, 11(1), 1-13. doi. 10.1371/ journal.pone.0144908
Black, R.E., Laxminarayan, R., Temmerman, M., & Walker, N. (2016). Reproductive, Maternal, Newborn, and Child Health. Disease Control Priorities, Third Edition, Vol.2. Washington, DC: World Bank. doi. 10.1596/978-1-4648-0348-2
Bridsall, N., & Griffin, C.C. (1988). Fertility and poverty in developing countries, Journal of Policy Modeling, 10(1), 29-55. doi. 10.1016/0161-8938(88)90034-8
Carine, R., Simon, C., & Véronique, F., (2008). Maternal mortality in developing countries, in R.D. Semba, & M.W. Bloem (eds.), Nutrition and Health: Nutrition and Health in Developing Countries, Humana Press, Totowa, NJ.
Central Bureau of Statistics, (2009). National Baseline Household Survey, Republic of the Sudan. [Retrieved from].
Chai, B.P., Mohamed, A.I., Chakraborty, N., & Andrew, K. (1996). Partitioning the effect of infant and child death on subsequent fertility: An exploration in Bangladesh, East-West Center Working Papers, No.458. [Retrieved from].
Choudhury, N., Moran, A.C., Alam, M.A., Ahsan, K.Z., Rashid, S.F., & Steatfield, P.K. (2012). Beliefs and practices during pregnancy and children birth in urban slums of Dhaka, Bangladesh. BMC Public Health, 12, 791. doi. 10.1186/1471-2458-12-791.
Chowdhury, A. (1988). The infant mortality-fertility debate: Some international evidence, Southern Economic Journal, 54(3), 666-674. doi. 10.2307/1059010
Chowdhury, A.M.R., Bhuiya, A., Chowdhury, M.E., Rasheed, S., Hussain, Z., & Chen, L.C. (2013). The Bangladesh paradox: Exceptional health achievements despite economic poverty. The Lancet, 382(9906), 1734-1745. doi. 10.1016/S010-6736
Chowdhury, M.E., Anisuddin, A., Kalim, N., & Koblinsky, M. (2009). Causes of maternal mortality decline in Matlab, Bangladesh. Journal of Health Population Nutrition, 27(2), 108-123.
Cutler, D., Deaton, A., & Lleras-Muney, A. (2006). The determinants’ of mortality. Journal of Economic Perspectives, 20(3), 97-120. doi. 10.1257/jep.20.3.97
El-Arifeen, S., Hill, K., Ahsan, K.Z., Jamil, K., Nahar, Q., & Steatfield, P.K. (2014). Maternal mortality in Bangladesh: A countdown to 2015 country case study. The Lancet, 384(9951), 1366-1374. doi. 10.1016/S0140-6736 (14) 60955-7
Farah, A.A., & Preston, S.H. (1982). Child mortality differentials in Sudan, population and Development Review, 8(2), 365-383. doi. 10.2307/1972992
Farahani, M., Subramanian, S.V., & Canning, D. (2009). Effects of state-level public spending on health on the mortality probability in India, Program Health Economics, 19(11), 1361-1376. doi. 10.1002/hec.1557
Federal Ministry of Health, (2002). 25 Years Strategic Plan for Health Sector, Federal Ministry of Health, Khartoum, Republic of the Sudan. [Retrieved from].
Filmer, D., & Pritchett, L. (1997). Child mortality and public spending on health: How much does money matter? World Bank, Policy Research Working Paper, No.1864. [Retrieved from].
Filmer, D., & Pritchett, L. (1999). The impact of public spending on health: Does money matter?, Social Science &Medicine, 49(10), 1309-1323. doi. 10.1016/S0277-9536(99)00150-1
Gil-Gomez, D., Carrasco-Portion, M., C.M., & Ruiz, T. (2006). Knowledge gaps in scientific literature on maternal mortality: a systematic review, Bulletin of the World Health Organization, 84(11), 903-909.
Granger, C.W.J. (1969). Investigating causal relations by econometric models and cross-spectral methods. Econometrica, 37(3), 424-438. doi. 10.2307/1912791
Hobcraft, J. (1992). Fertility patterns and child survival: A comparative analysis, Population Bulletin of the United Nations, No.33. [Retrieved from].
Javid, M., & Sharif, F. (2016). Environmental Kuznets curve and financial development in Pakistan. Renewable and Sustainable Energy Reviews, 29(54), 406-414. doi. 10.1016/j.rser.2015.10.019
Johansen, S. (1988). Statistical analysis of cointegration vectors, Journal of Economic Dynamics and Control, 12(2), 231-254. doi. 10.1016/0165-1889(88)90041-3
Klein, M.D., Clahr, J. (1958). Factors in the decline of maternal morality, Jama, 168(3), 237-242. doi. 10.1001/jama.1958.03000030009002
Loudon, I. (1992). Death in Childbirth. An International Study of Maternal Care and Maternal Mortality 1800–1950. Oxford: Clarendon.
Mojekwu, J.N., Ibekwe, U. (2012). Maternal mortality in Nigeria: Examination of intervention methods, International Journal of Humanities and Social Sciences, 2(20), 135-149.
Nafiu, L.A., Aauud, A.A., Adiukwu, R.N (2016). Determinants of maternal mortality in Somalia, The Pacific Journal of Science and Technology, 17(2), 318-328.
Paul, G., & Walque, D. (2012). Maternal & Child Health in Sudan, World Bank Group.
Pesaran, M.H., & Shin, Y. (1999). Autoregressive distributed lag modeling approach to cointegration analysis, in Storms, S. (Ed.), Econometrics and Economic Theory in the 20th Century: The Ranger Frisch Centennial Symposium. Cambridge University Press, Cambridge.
Pesaran, M.H., Shin, Y., & Smith, R.J. (2001). Bounds testing approaches to the analysis of level relationships. Journal of Applied Econometrics, 16(3), 289-326. doi. 10.1002/jae.616
Preston, S.H. (1975). The changing relation between mortality and level of economic development, Population Studies, 29(2), 231-248.
Sachs, J.D., & Warner, A.M. (1997). Fundamental sources of long-run growth, The American Economic Review, 87(2), 184-188.
Véronique, F., Chou, D., Ronsmans, C., Graham, W., & Say, L. (2013). Levels and causes of maternal mortality and morbidity, in R.E. Black, R. Laxminarayan, M. Temmerman, & N. Walker (eds), Reproductive, Maternal, Newborn and Child Health, Washington, DC: World Bank. doi. 10.1596/978-1-4648-0348-2
Weil, D.N. (2005). Accounting for the effect of health on economic growth, NBER Working Paper, No.11455. doi. 10.3386/w11455
Weil, D.N. (2013). Health and Economic Growth, Handbook of Economic Growth, Volume 2.June 24, [Retrieved from].
Witter, S. (2010). Free health care for under-five children and pregnant women in Northern Sudan: Progress so far and recommendations for the future, Federal Ministry of Health. doi. 10.13140/RG.2.2.16255.00160
World Health Organization. (2015). Sudan health profile 2015/ World Health Organization. Regional Office for the Eastern Mediterranean. No.WHO-EM/HST/231/E. [Retrieved from].
World Health Organization, (2009). Country Cooperation Strategy for WHO and Sudan, 2008-2013. No.WHO-EM/ARD/032/E [Retrieved from].
World Bank, (2017). World Development Indicators. [Retrieved from].
Zakir, M., & Phanindra, V.W. (1999). Factors affecting infant mortality rates: evidence from cross-sectional data. Applied Economics Letters, 6(5), 271-273. doi. 10.1080/135048599353203
