Improving Birth Outcomes Meeting the Challenge in the Developing World (2003) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-16
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PART I Meeting the Challenge in the Developing World
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Most maternal, neonatal, and fetal deaths occur between late pregnancy and the end of the first month of the child's life and many are preventable. Yet this important period has received inadequate attention in the health care programs of most countries.
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identify cost-effective opportunities for improving birth outcomes, reducing maternal, infant, and fetal mortality, and supporting families with an infant handicapped by birth problems; and 4) recommend priority research, capacity building, and institutional and global efforts to reduce adverse birth outcomes in developing countries.
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The combined weight of such evidence, the committee believes, has produced an accurate account of the state of knowledge concerning the epidemiology of neonatal and maternal mortality and morbidity and fetal mortality, prevention and care in developing countries, and the capacity of health care systems to provide appropriate prevention and care with limited resources. Evaluation of the evidence base enabled the committee to identify gaps in knowledge and to propose strategies for a research agenda that would fill these gaps.
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Malnourished mothers are at increased risk for complications and death during pregnancy and childbirth and their infants are more likely to have low birth weight, fail to grow at a normal rate, and have higher rates of disease and death. Women's education and socioeconomic status Maternal education, literacy, and overall socioeconomic status are powerful influences on the health of both mother and newborn.
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Those who reach an appropriate medical facility may also find that differences in language, behavior, and expectations between a woman experiencing complications and the medical staff limit her access to care. The invisibility of many fetal and neonatal deaths that occur at home, along with the widespread acceptance of these deaths, poses major barriers to reducing fetal and neonatal mortality.
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Inadequate data on birth outcomes The true magnitude of death, disease, and injury associated with poor birth outcomes in developing countries has not been established. Countries with the highest estimated maternal, neonatal, and fetal mortality rates also have the lowest registration of births and neonatal deaths; an even lower proportion of fetal deaths are recorded.
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With skilled assistance and access to the appropriate level of care, such complications can often be handled successfully. Where skilled health care services are not available and where many deliveries occur at home, as in many developing country settings, the proportion of intrapartum fetal deaths and overall fetal mortality are both much higher.
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Clearly, successful strategies to improve birth outcomes must not only address the direct causes of maternal, neonatal, and fetal mortality, but must also address their implementation within health care systems.
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More than 4 million children are born each year with birth defects.2 As infant mortality and morbidity due to infectious diseases and birth asphyxia are controlled, the relative contribution of birth defects increases. Risk factors for birth defects that may be higher in developing countries include infectious diseases and nutrient deficiencies in the mother during pregnancy.
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Where necessary, the birth attendant should also be prepared to stabilize and swiftly refer the mother and/or neonate to a facility providing essential obstetric and neonatal care (Chapters 2 and 3~.3 Future significant reductions in maternal, neonatal, and fetal mortality can be achieved if complications in labor and delivery are anticipated and addressed promptly. For example, treatments for hypertensive disease of pregnancy can prevent or minimize the recurrence of life-threatening convuisions; vacuum extraction, use of forceps, and cesarean section can be used to manage obstructed labor; preventive medications and blood transfusion can reduce maternal deaths due to postpartum hemorrhage.
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Several effective preconceptional and antenatal services, beginning with family planning, can reduce the risks for maternal, neonatal, and fetal mortality. These services, which can be provided in about five antenatal visits, can also course!
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improving Birth Outcomes in the Future Successful and sustained implementation of the first four recommendations requires the support of an effective health care system. Unfortunately,
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To improve birth outcomes over the long term, strategies need to be advanced at every level, from local communities to international bodies. National public health policy should seek to control preventable risk factors for maternal, neonatal, and fetal mortality, and to coordinate the many institutions and organizations involved in comprehensive reproductive care.
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After more than a decade of increased attention to maternal health care in the developing world, maternal mortality rates have not measurably declined. Meanwhile, although significant reductions in mortality rates in children under 5 years have been achieved during the 1990s, neonatal mortality rates, which now account for the majority of infant mortality, have declined far less quickly.
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