Global Health
The Influence of Political Determinants on Antenatal Care and Mortality in LMICs Sueny Paloma* Sueny Paloma Lima dos Santos Dr. Zelalem Haile
Antenatal care (ANC) is critical for improving maternal and child health (MCH) outcomes, yet disparities persist, particularly in low- and middle-income countries (LMICs). This study investigates the impact of political determinants—governance, corruption, and gender inequality—on MCH outcomes, including maternal mortality ratio (MMR), neonatal mortality rate (NMR), infant mortality rate (IMR), and under-5 mortality rate (URMR). Using country-level data from the World Bank, Demographic and Health Surveys, WHO, and UNICEF, we analyzed associations between governance indices and MCH outcomes. Negative binomial regression and mediation analysis were performed. The Global Women’s Health Index (HGWHI) and Universal Health Coverage (UHC) scores demonstrated significant negative associations with mortality outcomes (coefficients: -0.03 to -0.07, p < 0.001), while CCI showed similar trends (coefficients: -0.03 to -0.06, p < 0.001). Countries with higher UHC and CCI scores, such as Brazil and Malaysia, exhibited lower mortality rates, whereas lower scores in Afghanistan and Sierra Leone were associated with worse outcomes. The Gini Index, reflecting income inequality, showed weak and non-significant associations with mortality outcomes (coefficients: 0.00 to -0.01, p = 0.35). The Gender Inequality Index (GII) and Women’s Peace and Security Index (WPS) were critical determinants, with GII positively associated with mortality outcomes (coefficients: 4.44 to 8.02, p < 0.001) and WPS negatively associated (coefficients: -3.1 to -4.36, p < 0.001). Mediation analysis revealed UHC and CCI partially mediated the relationship between governance factors and IMR, URMR, and MMR, with significant indirect effects (Estimates: -0.0139 to -0.0251, p < 0.001). Sobel tests confirmed that the CCI mediated the relationship in NMR models, whereas CPI did not. These findings highlight the importance of governance and gender equity in reducing mortality and improving access to ANC. Policy recommendations include expanding UHC, addressing gender disparities, and implementing anti-corruption measures to improve equitable healthcare for women and children in LMICs.