Contraception and Reproduction Health Consequences for Women and Children in the Developing World (1989) / Chapter Skim
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3 Reproductive Patterns and Women's Health
3 Reproductive Patterns and Women's Health
Pages 25-35
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From page 25... ...
. In industrialized countries, maternal mortality was at about that same level at the turn of the century but has declined to a current level of less than 10 maternal deaths per 100,000 live births, with under 10,000 deaths per year.
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From page 26... ...
Thus, by convention, the number of live births is used as the denominator. The second measure is the maternal mortality rate or the maternal causespecific mortality rate, which is calculated by dividing the number of deaths due to pregnancy and childbirth by the number of women of reproductive ages.
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From page 27... ...
By contrast, in these same populations, current levels of infant mortality rates imply that there will be between 10,000 and 20,000 infant deaths per 100,000 live births. Since maternal death is a relatively rare event, accurate measurement of maternal mortality rates requires collecting data from a much larger population than would be required for accurate measurement of infant and child mortality.
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From page 28... ...
Even if national maternal mortality ratios cannot be accurately estimated with hospital data, if the assumption can be made that deaths in hospitals are representative of all maternal deaths, or if the way in which they are unrepresentative can be identified, then cause-specific mortality rates from these sources may be useful. Because of the very small numbers of deaths identified in populationbased studies, hospital-based studies provide valuable sources of data for examining the causes of high maternal mortality.
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From page 29... ...
Methodological Issues Aside from problems associated with the available data, studies of the association between reproductive patterns and maternal health are more limited than those available on child health for two methodological reasons. First, few of the available studies use multivariate statistical techniques to control for potentially confounding variables (see Appendix Table 3.A)
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From page 30... ...
EFFECTS OF OLDER MATERNAL AGE, HIGH PARITY, OR BOTH The problem of confounding between age and parity exists as well for births to older women, which are in most cases also high-order births. A pattern of generally increasing risk of maternal death with each successive birth after the second or third birth is evident in the information from three population studies.
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From page 31... ...
Antepartum hemorrhage can arise from several causes, the most important being placenta previa (a condition occurring when the placenta overlies the cervical opening of the uterus, resulting in massive, fatal hemorrhage at the time of attempted delivery unless a cesanan section is performed) and abruptia placenta (a condition occurring when the placenta separates prematurely from the uterus prior to delivery of the baby)
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From page 32... ...
Additional insights into the health consequences of unsafe abortion can be derived from the experience in Romania, where restrictive abortion laws were enacted after a history of relatively liberal laws, resulting in a sevenfold increase in maternal mortality due to abortion (Tietze, 1983~. At the same time, data from the United States demonstrates the extremely low risk of safe, first-trimester abortion procedures, making them one of the safest surgical procedures performed.
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From page 33... ...
; and reducing the demand for abortion to terminate unwanted pregnancies in countries where safe abortion is unavailable. APPENDIX TABLE 3.A Summary of Studies of Maternal Health Study Measures of Location Matemal Condition Tabulation Vanables POPULATION-BASED STUDES Alaudd~n, 1987 Bangladesh Matemal modality ratios Bhatia, 1985 India Matemal deaths Chen, Gesche, Bangladesh Ahmed, Chowdhury and Moseley, 1975 Matemal mortality ratios Age, parity, landholding, economic status, education, .
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From page 34... ...
. pnrmgravlaas She of the fetal head in relation to the maternal pelvis of women pregnant for the first time)
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From page 35... ...
2 Deaths due to pregnancy or childbirth per 100,000 women of reproductive ages.
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