Each year more than 500,000 women die due to complications from childbirth, making this a leading cause of death globally for adult women of reproductive age. Nearly all studies that have sought to explain the persistence of high maternal mortality levels have focused on the supply of and demand for particular health services.
We argue that inquiry on health services is useful but insufficient. Historical and social structural factors also shape maternal mortality levels, and the very emergence and effectiveness of safe motherhood programs that seek to make such services available. Robust explanations for safe motherhood outcomes require examination of factors lying deeper in the causal chain.
In this paper we compare the cases of Guatemala and Honduras to examine historical and structural influences on maternal mortality. Despite being a poorer country than Guatemala, Honduras has a superior safe motherhood record. We argue that three historical and structural factors stand behind this difference: Honduras’ relatively stable and Guatemala’s turbulent modern political history; a conservative Catholic Church in Guatemala but not Honduras that has blocked priority for reproductive health; and the presence of a marginalized indigenous population in Guatemala but not in Honduras that the state has had difficulty reaching.