Access to health services and maternal mortality in Ecuador: a case study in a public hospital

Abstract

Maternal mortality remains a major public health problem in many countries, particularly in Latin America and the Caribbean, due to its high incidence. Many maternal deaths are preventable and are linked to inadequate, inaccessible, or poor-quality health care, as well as social, economic, educational, regulatory, and family-related inequalities. Each maternal death reflects not only a health failure but also broader social inequities that limit women’s access to timely and effective care. This study aimed to develop and evaluate a model to improve access to maternal and child health services to reduce maternal mortality in a public hospital in Ecuador. A quantitative approach was used. The sample included 258 pregnant or puerperal women who received care at the hospital, divided into experimental and control groups. Following the implementation of the model, the experimental group showed improvements across all evaluated dimensions. Perceived availability of services increased (M = 42.82 to 43.94), affordability improved (M = 38.64 to 44.04), and perceived quality of care rose (M = 42.88 to 46.28). Mann–Whitney U-test results revealed statistically significant differences between the experimental and control groups after the intervention in all dimensions—availability, affordability, and quality of care (p < 0.005). These findings indicate that the model not only enhanced knowledge but also positively influenced women’s perceptions of, and interactions with, maternal and child health services. Finally, the proposed model demonstrated a significant and positive effect on access to maternal and child health services, as evidenced by differences between pretest and posttest scores in the experimental group.