1. 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). 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. 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. A Comparison of Neonatal Outcomes in Ecuador and USA Carla M. Breccia, author Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ 08854 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 References.Birth rate, crude (per 1,000 people). (n.d.). Retrieved November 2, 2014, from The World Bank. website: http://data.http://data worldbank.org/indicator/SP.DYN.CBRT.IN Birth rate - crude (per 1;000 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 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, 2002). Increasing compliance with maternal and child care quality standards in Ecuador. 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. Website:http://data.worldbank.org/indicator/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 ONE 9(3): e91292. doi:10.1371/journal.pone.0091292 Results 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. Figure 1: Birth Rate in Ecuador vs. USA Figure 2: Infant Mortality Rate in Ecuador vs. USA 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 Figure 3: Causes of Neonatal Fatality in Ecuador in 2008 This is an image of the Dr. Eduardo Estrella National Museum of Medicina http://fotos.lahora.com.ec/cache/3/39/393/3938/150-embarazadas-mueren-al-ano-antes-o-despues-del-parto-20110218100756-3938af2d4702cfb0b466c534e225f944.jpg This image is of me and my classmates while traveling in Ambato with Chimborazo in the background.