Social Inequalities and Gestational Risk in Rural and Urban Women: A Systematic Review of Literature

Palabras clave: Maternal mortality, social inequalities, rural health, social determinants of health, obstetric risk

Resumen

Maternal health reflects social equity and remains strongly influenced by the Social Determinants of Health (SDH), particularly in rural and low-resource settings. The objective was to describe social inequalities and their effect on pregnancy risk. This systematic review, conducted under PRISMA 2020 guidelines. The databases were PubMed, Scopus, and ScienceDirect. The synthesis of evidence reveals a direct correlation between the poverty index and the severity of complications. In various Latin American and middle-income country contexts, the maternal mortality ratio reached 75.19 per 1,000 live births, exceeding the national average, with critical vulnerability among women over 40 years of age (Ratio: 165.75). Although urban areas report a higher number of cases (251 vs. 165), rural areas face greater barriers related to the "third delay" (transportation and referral). The cost of care for severe preeclampsia (USD 827) acts as an impoverishment factor for low-income families, exacerbating the cycle of inequality. Social inequalities are not only geographical, but also structural and economic. A differentiated public policy is needed to mitigate the access gap in sparsely populated rural areas in order to effectively reduce maternal morbidity and mortality in the department.

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Rodríguez-Hernández JM, Ariza Ruiz LK, Castro Barbudo D, et al. Analysis of inequalities and inequities in maternal mortality in Chocó, Colombia. Int J Environ Res Public Health [Internet]. June 9, 2023; 20 (12): 6095. Available from: https://doi.org/10.3390/ijerph20126095

Rivillas JC, Devia-Rodríguez R, Ingabire MG. Measuring socioeconomic and health financing inequality in maternal mortality: a mixed methods approach. Int J Equity Health [Internet]. July 31, 2020; 19 (1): 98. Available from: https://doi.org/10.1186/s12939-020-01219-y

Gomez de la Rosa F, Marrugo-Arnedo CB, Florez-Tanus A, et al. Reduction of maternal mortality due to preeclampsia in Colombia - an interrupted time- series analysis. Salud Publica Mex [Internet]. 2017; 59:176-82. Available from: https://doi.org/10.21149/7766

Calu Costa J, Victora CG, Mujica OJ, et al. Inequalities in health, nutrition, and well-being of Afro-descendant women and children in Latin America and the Caribbean. Lancet Reg Health [Internet]. 2022; 10 (1): e42-e53. Available from: https://doi.org/10.1016/j.lana.2022.100345

Sanhueza A, Calu Costa J, Mújica OJ, et al. Trends and inequities in adolescents childbearing in Latin America and the Caribbean. Lancet Child Adolesc Health [Internet]. 2023;17:100397. Available from: https://doi.org/10.1016/S2352-4642(23)00077-9

Castañeda-Orjuela C, Hilarion L, Diaz-Jimenez D, et al. Maternal mortality in Colombia during the COVID-19 pandemic: time series and social inequities. BMJ Open [Internet]. 2023; 13: e064960. Available from: https://doi.org/10.1136/bmjopen-2022-064960

Armenta-Paulino N, Arroyave L, Victoria CG, et al. Ethnic inequalities in health intervention coverage among Mexican Women at the individual and municipality levels. EClinicalMedicine [Internet]. 2021; 43:101228. Available from: https://doi.org/10.1016/j.eclinm.2021.101228

Rios-Quituizaca P, Gatica-Domínguez G, Nambiar D, et al. Ethnic inequalities in reproductive, maternal, newborn and child health interventions in Ecuador: A study of the 2004 and 2012 national surveys. EClinicalMedicine [Internet]. 2020; 45: 101322. Available from: https://doi.org/10.1016/j.eclinm.2022.101322

Pescarini JM, Falcao IR, Reboucas P, et al. Perinatal health outcomes of internal migrant women in Brazil:A nationwide data linkage study of the CIDACS birth cohort (2011–2018). Travel Med Infect Dis [Internet]. 2024; 57: 102672. Available from: https://doi.org/10.1016/j.tmaid.2023.102672

Escobar MF, Echavarría MP, Carvajal JA, et al. Hospital padrino: a collaborative strategy model to tackle maternal mortality: a mixed methods study in a middle-income region. Lancet Reg Health Am [Internet]. 2024; 31: 100705.

Available from: https://doi.org/10.1016/j.lana.2024.100705

Moreira TR, Barbosa do Nascimento Einloft A, Dias da Costa G, et al. Data quality and arbovirus infection associated factors in pregnant and non-pregnant women of childbearing age in Brazil: A surveillance database analysis. One Health [Internet]. 2021; 12: 100244. Available from: https://doi.org/10.1016/j.onehlt.2021.100244

Pescarini JM, Goes EF, Smeeth L, et al. Mortality among over 6 million internal and international migrants in Brazil: a study using the 100 Million Brazilian Cohort. Lancet Reg Health Am [Internet]. 2023; 20: 100455. Available from: https://doi.org/10.1016/j.lana.2023.100455

Balaj M, Sripada K, Besnier E, et al. Parental education and inequalities in child mortality: a global systematic review and meta-analysis. Lancet [Internet]. 2021; 398 (10300): 608-620. Available from: https://doi.org/10.1016/S0140-6736(21)00534-1

Kong Y, Chen S, Ma N, et al. Association between concurrence of multiple risk factors and under-5 mortality: a pooled analysis of data from Demographic and Health Survey in 61 low-and-middle-income countries. EClinicalMedicine [Internet]. 2024; 71: 102583. Available from: https://doi.org/10.1016/j.eclinm.2024.102583

Jennie B. Gamlin. "You see, we women, we can't talk, we can't have an opinion…". The coloniality of gender and childbirth practices in Indigenous Wixárika families. Soc Sci Med [Internet]. 2020; 252: 112912. Available from: https://doi.org/10.1016/j.socscimed.2020.112912

Hone T, Gonçalves J, Seferidi P, et al. Progress towards universal health coverage and inequalities in infant mortality: an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019. Lancet Glob Health [Internet]. 2023;11(4):e526-e536. Available from: https://doi.org/10.1016/S2214-109X(24)00040-8

Huda TM, Alam A, Tahsina T, et al. Mobile-based nutrition counseling and cash transfers for improving maternal and child health in Bangladesh: pilot study. JMIR Mhealth Uhealth [Internet]. 2018; 48 (6): e156. Available from: https://doi.org/10.2196/mhealth.8832

Wilson CA, Bublitz M, Chandra P, et al. A global perspective: Access to mental health care for perinatal populations. Semin Perinatol. [Internet]. 2024; 48 (6): 151942. Available from: https://doi.org/10.1016/j.semperi.2024.151942

Cantor D, Swartz J, Bayard Roberts, et al. Understanding the health needs of internally displaced persons: A scoping review. J Migr Health [Internet]. 2021; 4: 100071. Available from: https://doi.org/10.1016/j.jmh.2021.100071

Rosario A, Gau A, Munsterman E, et al. Decolonizing nursing for health equity: a scoping Review. Nurs Outlook [Internet]. 2024; 72 (5): 102230. Available from: https://doi.org/10.1016/j.outlook.2024.102230

Leventhal DGP, Crochemore -Silva I, Vidaletti LP, et al. Delivery channels and socioeconomic inequalities in coverage of reproductive, maternal, newborn, and child health interventions: analysis of 36 cross-sectional surveys in low-income and middle-income countries. Lancet Glob Health [Internet]. August 2021; 9 (8): e1101-e1109. Available from: https://doi.org/10.1016/S2214-109X(21)00204-7

GBD 2019 Universal Health Coverage Collaborators. Measuring universal health coverage based on an index of effective coverage of health Services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet [Internet]. 2020; 396 (10258): 1250-1284. Available from: https://doi.org/10.1016/S0140-6736(20)30750-9

Joshi A. Legal Empowerment and Social Accountability: Complementary Strategies Toward Rights-based Development in Health? World Development[Internet]. 2017; 99: 160-172. Available from: https://doi.org/10.1016/j.worlddev.2017.07.008

Cardona-Arias JA, Higuita-Gutiérrez LF, Carmona-Fonseca J. Lifestyles associated with malaria in pregnancy in northwest Colombia: a mixed study from Latin American critical epidemiology. Malar J [Internet]. 2024; 23 (1): 221. Available from: https://doi.org/10.1186/s12936-024-05046-2

Mattsson K, Gustafsson J, Prada S, et al. Mapping socio-geographical disparities in the occurrence of teenage maternity in Colombia using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA). Int J Equity Health[Internet]. 2024; 23(1): 36. Available from:

https://doi.org/https://doi.org/10.1186/s12939-024-02123-5

Chiavaroli V. The reproductive geography of miscarriages: social identities, places, and inequalities. Soc Sci Med [Internet]. 2024; 360:117351. Available from: https://doi.org/10.1016/j.socscimed.2024.117351

García-Balaguera C, Vargas M, Guzmán L, et al. Maternal Mortality, Health Determinants, and Covid-19 in the Department of Meta, Colombia: A Cross-sectional Study. Open Public Health J [Internet]. 2024;48:e15.

Available from: https://doi.org/10.2174/011874944527744224022010

Serván-Mori E, Meneses-Navarro S, García-Diaz R, et al. Ethnic and racial discrimination in maternal health care in Mexico: a neglected challenge in the search for universal health coverage. Int J Equity Health [Internet]. 2025;24(1):10. Available from: https://doi.org/10.1186/s12939-024-02374-2

Akseer N, Keats EC, Thurairajah P, et al. Characteristics and birth outcomes of pregnant adolescents versus older women: secondary analysis of 140,000 mothers from 20 randomized trials. Lancet Child Adolesc Health [Internet]. July 2022;6(7):479-490. Available from: http://dx.doi.org/10.2139/ssrn.387538

Publicado
2026-07-14
Cómo citar
Torres Ferro , S., Conde Avilés, S. A., Sánchez Caicedo, C. F., Fonseca Santander, M. D., Felipe Rivera, A., & Charry Cuellar, J. D. (2026). Social Inequalities and Gestational Risk in Rural and Urban Women: A Systematic Review of Literature. Ciencia Latina Revista Científica Multidisciplinar, 10(3), 6730-6743. https://doi.org/10.37811/cl_rcm.v10i3.24736
Sección
Ciencias de la Salud