Association for Public Policy Analysis & Management

Maternal deaths are a pervasive problem in many countries. In 2015, over 300,000 women and adolescent girls died from pregnancy and childbirth complications (WHO, 2016). While maternal mortality is higher in resource-limited contexts, the situation is a growing problem worldwide, including developed countries. Some of the countries in the Organization for Economic Cooperation and Development (OECD), like the United States (US) and Mexico, experience relatively high levels of maternal mortality: the US had 14 maternal deaths per 100,000 live births and Mexico had 41 in 2015. This number situated Mexico at the top of the list among OECD countries. In fact, Mexico City, representing the country’s best health care system, had 61.7 maternal deaths per 100,000 live births. To respond to this dire situation, the Secretary of Health of Mexico City (SEDESA) adopted and implemented an innovative program called Doctor at Your Home in 2014.

Doctor at Your Home aims to address low levels of prenatal care utilization and improve maternal health. Through the program, social workers visit households looking for pregnant women without prenatal care and refer them to a health center for prenatal care consults. During the visit, social workers advise the mother-to-be to adopt a healthy diet, recommend she gets prenatal care, and explain how she can identify signs of common pregnancy complications. If the mother-to-be is not receiving prenatal care, the social worker provides her a 48-hour pass to go to her nearest health center for treatment. If she does not attend within that period of time, a physician visits her to evaluate the overall health of the pregnancy. Based on the evaluation, she is referred to a health center for follow-up prenatal care consults. In each consult, patients obtain a healthy food package including prenatal vitamins.

This study provides the first evaluation of the program’s impacts. Using data from birth certificates and administrative records over 2008-2017, this paper evaluates the effect of this intervention on prematurity, low birth weight and maternal mortality rates. The empirical approach takes advantage of the program’s roll out. In particular, it uses variation in the time the program began operating in each Mexico City county to estimate a differences-in-differences model, comparing outcomes in counties implementing DH in a particular year to counties that did not, before and after DH started in a given county. In addition, it uses a synthetic control approach to construct a control group from counties that integrate the Mexico City Metropolitan Area but were not treated because of a different state government.

Preliminary findings suggest the program reduced maternal deaths in 53.27 per 100,000 live births. The effects are immediate and persist over time. In addition, the program increased birth weight in 31.28 grams and decreased the probability of preterm in 1.2 percent. The results of this study indicate the value for implementing similar healthcare efforts in other developing settings, especially those with similarly scarce resources.