Improving Birth Outcomes Meeting the Challenge in the Developing World (2003) / Chapter Skim
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1. Introduction
1. Introduction
Pages 17-40
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From page 17... ...
The Safe Motherhood Initiative began in 1987 to address this gap in programming. However, after more than a decade of increased attention to maternal health care in the developing world, maternal mortality rates have not measurably declined (Weil and Fernandez, 1999; World Health Organization, 1999; AbouZhar and Wardiaw, 2001~.
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From page 18... ...
It will review the statistics of low birth weight and premature infants and birth defects; review current knowledge and practices, identify costeffective opportunities for improving birth outcomes and supporting families with an infant handicapped by birth problems, and recommend priority research, capacity building, and institutional and global efforts to reduce adverse birth outcomes in developing countries. The committee will base its study on data and information from several developing countries, and provide recommendations that can assist the Centers for Disease Control and Prevention, the National Institute for Child Health and Human Development, and the U.S.
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From page 19... ...
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
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From page 20... ...
Clearly, health conditions are influenced by the social and political context of countries and communities, which may directly or indirectly contribute to adverse birth outcomes (Tinker, 2000~. While acknowledging the profound influence of sociopolitical factors on birth outcomes and supporting efforts to counteract negative effects, this report focuses on improvements in health care and medical interventions that can produce a more rapid reduction in maternal, neonatal, and fetal mortality.
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From page 21... ...
The immediate effects of weak national and local economies on birth outcomes are predictable: limited resources typically reduce the availability of goodquality health services, including obstetric and neonatal care (The Prevention of Maternal Mortality Network, 1992~. Family income has been shown to be highly correlated with perinatal mortality in India (Saksena and Srivastava, 1980)
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From page 22... ...
Malnourished mothers are at increased risk for complications and death during pregnancy and childbirth. In addition, their children are likely to have low birth weight, fail to grow at a normal rate, and have higher rates of disease and early death (Tinker, 2000; United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition, 1994~.
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From page 23... ...
The gap between female and male literacy in the developing world is significant; in 1990, 18 countries were found to have a female literacy rate less than half that of males (United Nations Children's Fund, 1995~. Multiple regression analyses of global data compiled by the United Nations revealed that the combination of GDP and female literacy accounted for 80 percent of the variation in infant mortality rates among 155 countries, and that female literacy appeared to be a factor underlying global variation in the proportion of health personne!
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From page 24... ...
mother; birth intervals of less than 2 years; and four or more older children (Cooperative for Assistance and Relief Everywhere, 1997~. Advanced maternal age has consistently been associated with increased risk for fetal and early neonatal deaths (Nybo Andersen et al., 2000; Murphy et al., 1987; Onadeko et al., 1996; Stanley and Stratton, 1981; Saksena and Srivastava, 1980; Barros et al., 1987~.
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From page 25... ...
Another study in Sweden has found that short interpregnancy intervals appear not to be causally associated with increased risk of stillbirth and early neonatal death, whereas long interpregnancy intervals were associated with increased risk of stillbirth and possibly early neonatal death (Stephansson et al., 2003~. With respect to the association of birth intervals with maternal mortality and morbidity, only one large-scale analysis has been undertaken.
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From page 26... ...
Pregnancy is widely considered to be a time of well-being; complications may be viewed as fated, or even brought on by a woman's misbehavior. Where such beliefs prevail, women and traditional birth attendants tend to perceive obstetric complications as supernatural in origin, and best treated through traditional means (National Research Council, 1997; The Prevention of Maternal Mortality Network, 1992~.
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From page 27... ...
are recorded by civil registration systems for the purpose of monitoring maternal mortality (AbouZhar and Wardiaw, 2001~. Similarly, the majority of early neonatal deaths and almost all fetal deaths in developing countries many of which occur at home are not registered, rendering them invisible to health leaders (Tewkes and Wood, 1998; Lumbiganon et al., 1990; McCaw-Binns et al., 1996~.
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From page 28... ...
Neonatal mortality The principal direct causes of neonatal death are infectious diseases, birth asphyxia, birth defects, and the sequelae of preterm birth and intrauterine growth restriction. During the early neonatal period (0-7 days)
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From page 29... ...
Antepartum fetal deaths are associated with risks such as maternal conditions, obstetric complications, and advanced maternal age (Conde-Agudelo et al., 2000; Sheiner et al., 2000; Ananth et al., 1999; Seoud et al., 2002~. Linking the Mother, Fetus, and Neonate Many risk factors affecting the outcomes of mother, fetus, and neonate overlap.
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From page 30... ...
As infant mortality and morbidity are reduced through the control of infectious diseases, birth asphyxia, and other causes, the relative contribution of birth defects to the burden of disease in developing countries is expected to
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From page 31... ...
Child Survival and Safe Motherhood Leaders and policymakers concerned with maternal and child health have long emphasized the need to reduce both early childhood mortality and, more recently, maternal mortality. A brief history of the two major initiatives toward these goals those in child survival and safe motherhood is provided here, as this study recommends building on their successes.
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From page 32... ...
While the Child Survival Initiative through the United States Agency for International Development (USAID) has a specific focus, safe motherhood issues are much broader, encompassing family planning, antenatal care, clean and safe delivery, essential obstetric care, basic maternity care, primary health care, and equity for women.
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From page 33... ...
In 2000, drawing on the research findings and evaluations of the safe motherhood initiative, WHO launched a 5-year program, the Making Pregnancy Safer initiative. This initiative stresses specific health sector actions, including family planning, antenatal care, the presence of a skilled attendant at every birth, referral centers providing good-quality obstetric services, and basic postpartum care (WorId Health Organization, 2000~.
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From page 34... ...
This report recommends cost-effective interventions already shown to reduce neonatal and fetal mortality. Such interventions can be added to or emphasized in existing maternal and child health programs, but it will also be necessary to expand the current focus of the child survival and safe motherhood initiatives to fully recognize and address the issue of improving neonatal health.
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From page 35... ...
2001. Maternal mortality at the end of a decade: signs of progress?
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From page 36... ...
1994. Social and environmental factors and life expectancy, infant mortality, and maternal mortality rates: results of a cross-national comparison.
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1990. Why are Thai official perinatal and infant mortality rates so low?
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From page 38... ...
2003. Interpregnancy interval and risk of preterm birth and neonatal death: retrospective cohort study.
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From page 39... ...
1992. Maternal education in relation to early and late child health outcomes: findings from a Brazilian cohort study.
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From page 40... ...
1999. Reduction of Maternal Mortality: A Joint WHO/ UNFPA/UNICEF/VDorld Bank Statement.
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