Ecuador is classified as a developing country and therefore has healthcare standards that vary from those of the United States, including the precautions and measures taken during labor, intrapartum and post partum. A large majority of births in Ecuador

1
A Comparison of Neonatal Outcomes in Ecuador
and USA Carla M. Breccia, author
Rutgers-Robert Wood Johnson Medical School,
Piscataway, NJ 08854

• Conclusions
• There is an increased percentage of birth
  asphyxias and infectious causes of neonatal death
  in Ecuador.
• This can be partially attributed to low rate and
  frequency of maternal, fetal and neonatal
  monitoring in Ecuador and the conditions most
  children in Ecuador are born into that increase
  airborne and indirect transmission of pathogens
• These causes of neonatal death in Ecuador are
  ones that can be prevented with improved
  standards of care and healthcare setting and can
  be explained, at least partially, by the hospital
  conditions as hypothesized
• As Ecuador continues to develop, its health care
  standards are improving rapidly and with this
  will hopefully come a continued decrease in
  infant mortality rate and improved conditions of
  public maternity hospitals.

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• Purpose
• to get a better understanding of prenatal
  conditions in Ecuador
• to see if the differences in standard of care in
  the two countries translates into differences in
  infant mortality
• to see if the differences in standard of care in
  the two countries translates into differences in
  causes of neonatal death

Results

• Introduction
• Ecuador is classified as a developing country
  and therefore has healthcare standards that vary
  from those of the United States, including the
  precautions and measures taken during labor,
  intrapartum and post partum. A large majority of
  births in Ecuador take place in public maternity
  hospitals, where ten to fifteen women are giving
  birth in the same room, all of whom are monitored
  at rates that fall well below standards set by
  the World Health Organization (Burkhalter et al,
  2006). Burkhalter et al. found that only 31.7
  of the time healthcare workers wash their hands
  prior to putting on sterile gloves, only 36.6
  suction the newborn after birth and only 9.8
  establish skin-to-skin contact between child and
  mother.
• The Ministry of Health of Ecuador recognized
  these deficits in their healthcare standards and
  implemented the Healthy Maternity program.
  This program aimed to improve child and maternal
  care by altering the way in which hospitals
  received funding to be based on the number of
  services provided monthly (Hermida and Robalino,
  2002). In addition to this program, a quality
  assurance study aimed to improve the instruments
  available for both maternal and child care,
  hourly monitoring of the mother and child during
  labor and post partum and education of mothers on
  the warning signs of a sick child. This program
  markedly improved hospital compliance with
  clinical standards.
• Other efforts that the country of Ecuador
  makes to continue improving maternal and child
  care focus on sexual and reproductive rights.
  Unlike most other countries in Latin America,
  Ecuador guarantees sexual and reproductive health
  rights to all of its citizens (CFHI, 2006).
  Programs such as Centro Médico de Orientación y
  Planificatión Familiar (CEMOPLAF) and La
  Fundación Ecuatoriana Equidad (EQUIDAD) work to
  provide services (medical and educational) to
  mothers, children and families who may not have
  access to similar care.
• These interventions appears to be effective,
  seen with the drop in maternal mortality rate
  from 90 per 100,000 in 2010 to 87 in 2013 and the
  steady drop in infant mortality since 1989
  (worldbank.org).

Figure 1 Birth Rate in Ecuador vs. USA
In this figure we can see the steady decline in
birth rate in Ecuador over the past 23 years,
while the same rate in the USA has stayed
relatively constant.
This is an image of the Dr. Eduardo Estrella
National Museum of Medicina
Figure 2 Infant Mortality Rate in Ecuador vs. USA
Methods A large amount of pregnant women were
observed throughout my travels in Ecuador as well
as in the public clinic. This large number of
pregnant women was not represented at Hospital de
los Valles, the private hospital where I did most
of my shadowing, which puzzled me. I inquired
about this observation to our program coordinator
and he informed me about the public maternity
hospitals, most specifically Maternidad Isidro
Ayora in Quito. Unfortunately, I was not able to
shadow at la Maternidad, but I feel as though I
got a good description from our program director
and from pictures. Upon learning about the
conditions of these hospitals, it sparked my
interest to see if there was a large difference
in neonatal infections and mortality rates
between the USA and Ecuador. Upon returning home,
a literature search was done to find concrete
numbers that could be compared. After finding
the values, they were compared and conclusions
were drawn.
In this figure we can see the steady decline in
Infant mortality rate in Ecuador over the past 24
years, while the same rate in the USA only
slightly decreased.
Figure 3 Causes of Neonatal Fatality in USA in
2008
This image is of me and my classmates while
traveling in Ambato with Chimborazo in the
background.

• References
• .Birth rate, crude (per 1,000 people). (n.d.).
  Retrieved November 2, 2014, from The World Bank.
  website http//data.
• worldbank.org/indicator/SP.DYN.CBRT.IN
• Birth rate - crude (per 1000 people) in Ecuador.
  (n.d.). Retrieved November 2, 2014, from Trading
  Economics website http//www.tradingeconomics.com
  /ecuador/birth-rate-crude-per-1-000-people-wb-data
  .html
• Black, R. E., Cousens, S., Johnson, H. L., Lawn,
  J. E., Rudan, I., Bassani, D. G., Jha, P., ...
  Child Health Epidemiology Reference Group of WHO
  and UNICEF. (January 01, 2010). Global, regional,
  and national causes of child mortality in 2008 a
  systematic analysis. Lancet, 375, 9730, 1969-87
• Burkhalter B, W Edson, S Harvey, M Boucar, S
  Djibrina, J Hermida,P Ayabaca, M Bucagu, S
  Gbangbade, and A McCaw-Binns. 2006. Quality of
  obstetric care observed in 14 hospitals in Benin,
  Ecuador, Jamaica, and Rwanda. Operations Research
  Results. Published for the U.S. Agency for
  International Development (USAID) by QAP.
• Conde-Agudelo, Agustin, Belizán, José M.
  (n.d.). Maternal morbidity and mortality
  associated with interpregnancy interval cross
  sectional study. BMJ.
• Hermida, J., Robalino, M. E. (January 01,
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  International Journal for Quality in Health Care
  Journal of the International Society for
  Quality in Health Care / Isqua, 14, 25-34.
• Mortality rate, infant (per 1,000 live births).
  (n.d.). Retrieved November 2, 2014, from The
  World Bank. Websitehttp//data.worldbank.org/indi
  cator/SP.DYN.IMRT.IN
• Sexual health as a human right Ecuador's unique
  model. (n.d.). Retrieved November 4, 2014, from
  Child Family Health International website
  http//www.cfhi.org/web/index.php/program/show/id/
  
• Woodhouse C, Lopez Camelo J, Wehby GL (2014) A
  Comparative Analysis of Prenatal Care and Fetal
  Growth in Eight South American Countries. PLoS
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Figure 3 Causes of Neonatal Fatality in Ecuador
in 2008