Evaluation of maternal mortality in Ecuador between 2012 and 2022: impact and results of ESAMyN

Abstract

Introduction: maternal mortality constitutes a critical public health indicator and reflects social inequalities and deficiencies in health systems.

Objective: to evaluate the impact of the ESAMyN regulation on the reduction of maternal mortality in Ecuador between 2012 and 2022.

Methods: a retrospective review was conducted using databases from the Ministry of Public Health, the National Institute of Statistics and Census, SciELO, Scopus, and Google Scholar, focusing on articles published between 2020 and 2024 related to maternal mortality and health policies. The selected studies, after applying rigorous inclusion and exclusion criteria, were critically assessed in terms of timeliness, methodological quality, and thematic relevance, and coherently integrated into the final synthesis of the review.

Development: findings show that, despite the implementation of ESAMyN in 2016, Ecuador continues to have one of the highest maternal mortality rates in the region. The main causes were gestational hypertension, postpartum hemorrhage, and eclampsia. The regulation introduced perinatal care standards, hospital certification, and promotion of humanized childbirth, but results were heterogeneous. Gaps in access to services, territorial inequalities, and limitations in human resources persist. Evidence suggests that the regulation has partially contributed to improving the quality of care, although it has not achieved a sustained reduction in mortality.

Conclusions: the analysis confirms that the ESAMyN regulation represents progress in maternal care but requires strengthening in coverage, equity, and sustainability to achieve an effective reduction in maternal mortality.