Reproductive Health Matters articles from November 2007

Reproductive Health Matters archives from November 2007

Maternal mortality and morbidity: is pregnancy getting safer for women?(Editorial)
November 1, 2007... THIS year is the 20th anniversary of the WHO Safe Motherhood Initiative, which was launched in Nairobi in 1987. As RHM's contribution to the knowledge base to inform safe motherhood programmes in future, we asked whether pregnancy is getting...

Maternal mortality and maternity care from 1990 to 2005: uneven but important gains.
November 1, 2007... Abstract: Maternal mortality continues to be the major cause of death among women of reproductive age in many countries. Data from published studies and Demographic and Health Surveys show that gains in reducing maternal mortality between 1990...

Improving maternal health: getting what works to happen.
November 1, 2007... Abstract: Maternal mortality reduction in many countries is unlikely despite the availability of inexpensive, efficacious interventions that are part of official policy. This article explores the reasons why, based on research on maternity...

Making systems work: the hard part of improving maternal health services in South Africa.
November 1, 2007... Abstract: As part of a multi-country study, maternal health services were reviewed in one health district in Gauteng Province, South Africa. Poor record-keeping, inadequate supervision, poor levels of clinical knowledge and under-utilisation of...

Educating skilled birth attendants in Mexico: do the curricula meet International Confederation of Midwives standards?
November 1, 2007... Abstract: Although the majority of births in Mexico are attended by skilled birth attendants, maternal mortality remains moderately high, raising questions about the quality of training and delivery care. We conducted an exhaustive review of...

The experience of Ghana in implementing a user fee exemption policy to provide free delivery care.
November 1, 2007... Abstract: In resource-poor countries, the high cost of user fees for deliveries limits access to skilled attendance, and contributes to maternal and neonatal mortality and the impoverishment of vulnerable households. A growing number of...

Improving emergency obstetric care in a context of very high maternal mortality: the Nepal safer Motherhood Project 1997-2004.
November 1, 2007... Abstract: The Nepal Safer Motherhood Project (1997-2004) was one of the first large-scale projects to focus on access to emergency obstetric care, covering 15% of Nepal Six factors for success in reducing maternal mortality are applied to...

Support to the Safe Motherhood Programme in Nepal: an integrated approach.
November 1, 2007... Abstract: Evidence gathered from 1997 to 2006 indicates progress in reducing maternal mortality in Nepal, but public health services are still constrained by resource and staff shortages, especially in rural areas. The five-year Support to the...

Persistence of high maternal mortality in Koppal district, Karnataka, India: observed service delivery constraints.
November 1, 2007... Abstract: Rural women with obstetric complications access many health providers in Koppal, the poorest district in the state of Karnataka, south India. Yet they die. Based on insights derived from case studies of women seeking emergency...

Evoking the guardian angel: childbirth care in a Palestinian hospital.
November 1, 2007... Abstract: The purpose of this study was to assess the quality of maternity care in a large, public, Palestinian referral hospital, as a first step in developing interventions to improve safety and quality of maternity care. Provider interviews,...

Consequences of birth policies and practices in post-reform China.
November 1, 2007... Abstract: This paper comments on the provision of birthing services in Sichuan and Shanxi Provinces in China within a policy context. The goal was to understand possible unintended and harmful health outcomes for women in the light of...

Research on severe maternal morbidities and near-misses in brazil: what we have learned.
November 1, 2007... Abstract: The occurrence of complications during pregnancy depends less on the degree of human development than differences in the way complications in pregnancy are detected and managed. It is the quick diagnosis and correct management that...

Maternal mortality in Pernambuco, Brazil: what has changed in ten years?
November 1, 2007... Abstract: This study examines changes in levels and patterns of maternal mortality in Pernambuco, Brazil, in 1994 and 2003. The research was carried out in five sub-regions of Pernambuco using the Reproductive Age Mortality Survey (RAMOS)...

The introduction of confidential enquiries into maternal deaths and near-miss case reviews in the WHO European Region.
November 1, 2007... Abstract: Most maternal deaths can be averted with known, effective interventions but countries require information about which women are dying and why, and what can been done to prevent such deaths in future. This paper describes the...

Misclassified maternal deaths among East African immigrants in Sweden.
November 1, 2007... Abstract: Western countries have reported an increased risk of maternal mortality among African immigrants. This study aimed to identify cases of maternal mortality among immigrants from the Horn of Africa living in Sweden using snowball...

Monitoring maternity mortality in Botswana.
November 1, 2007... Abstract: This paper describes the maternity monitoring system in Botswana, developed in 1998, and the main methods used: maternal death and morbidity reviews at service delivery level, analysis by the National Maternal Mortality Audit...

Unmonitored intrapartum oxytocin use in home deliveries: evidence from Uttar Pradesh, India.
November 1, 2007... Abstract: Intrapartum use of oxytocin should entail controlled dosages administered through infusion, continual monitoring of mother and fetus and surgical back-up, since several adverse outcomes have been reported. However, in Uttar Pradesh,...

Global progress in PMTCT and paediatric HIV care and treatment in low- and middle-income countries in 2004-2005.(prevention of mother-to-child transmission)
November 1, 2007... Abstract: A growing number of countries are moving to scale up interventions for prevention of mother-to-child transmission (PMTCT) of HIV in maternal and child health services. Similarly, many are working to improve access to paediatric HIV...

Seizing the big missed opportunity: linking HIV and maternity care services in sub-Saharan Africa.
November 1, 2007... Abstract: This paper draws on two reviews commissioned by the UK Department for International Development in 2006-2007 that explore progress in linking HIV prevention and maternity services in sub-Saharan Africa. Although pilot and...

Abortion policies and practices in Chile: ambiguities and dilemmas.
November 1, 2007... Abstract: Abortion is not legal in Chile even to save the woman's life or health. This situation creates serious dilemmas and vulnerabilities for both women and medical practitioners. Abortion incidence has probably decreased since 1990, when...

Dear Minister.(ROUNDTABLE: IS PREGNANCY GETTING SAFER FOR WOMEN?)
November 1, 2007... MOTHERS are still dying during childbirth in your country. We write to you for this reason and because this is a crucial year for accelerating progress towards the Millennium Development Goal for maternal mortality--a three-quarters reduction...

Making pregnancy safer in Myanmar: introducing misoprostol to prevent post-partum haemorrhage as part of active management of the third stage of labour.(ROUNDTABLE: IS PREGNANCY GETTING SAFER FOR WOMEN?)
November 1, 2007... IN Myanmar, we carried out a successful pilot intervention with the prostaglandin misoprostol in the active management of the third stage of labour, for prevention of post-partum haemorrhage. The pilot aimed to appraise the operational...

Celebrating progress toward safer pregnancy.(ROUNDTABLE: IS PREGNANCY GETTING SAFER FOR WOMEN?)
November 1, 2007... THE Safe Motherhood Initiative was launched in 1987, so this year sees in its 20th anniversary. Global campaigns to mobilise resources and turn attention to the burden of death and illness faced by women during pregnancy, especially in...

Health system strengthening: new potential for public health and human rights collaboration.(ROUNDTABLE: IS PREGNANCY GETTING SAFER FOR WOMEN?)
November 1, 2007... IS pregnancy getting safer for women? It depends. It depends on where a woman is born, her social class, ethnic group or other marker of social and geographic positioning. While specific changes in medical techniques or fashions may...

Experiences of sexual harassment of women health workers in four hospitals in Kolkata, India.(OTHER FEATURES)
November 1, 2007... Abstract: In 1997, the Supreme Court of India recognised sexual harassment in the workplace as a violation of human rights. However, little is known about the extent or persistence of sexual harassment. To obtain an understanding of women's...

Abortion: an open secret? Abortion and social network involvement in Burkina Faso.(OTHER FEATURES)
November 1, 2007... Abstract: Abortion in Burkina Faso is a subject that neither abortion providers nor women want to talk about. Abortion providers fear criminal prosecution; women's silence is dictated more by the wish to avoid the stigma of a "shameful"...

Knowledge gaps in the literature on maternal mortality: a systematic review.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... This systematic review of scientific literature on maternal mortality assessed the proportion of research literature on specific causes of maternal mortality in relation to the corresponding burden of each cause. It found disproportionately...

Use of confidential enquiries into maternal deaths in developing countries.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... Countries with the highest maternal mortality ratios are the least likely to have experience of conducting confidential enquiries, though they offer a good opportunity to link practice to policy and make the greatest impact on maternal...

Association between stillbirth and maternal death.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... It has been observed that there is a relationship between maternal deaths and stillbirth following complications of obstructed labour and sepsis. This research examines the relationship of both of these to three measures of obstetric care using...

Single-dose methotrexate for ectopic pregnancy.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... The current protocol for predicting the success of single-dose methotrexate in treating ectopic pregnancy entails measurement of hCG levels at days 4-7 following administration of methotrexate. A greater than 15% decrease in hCG is thought to...

Hospitalisations following unsafe abortions in 13 developing countries.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... Global estimates of hospitalisations for complications of unsafe abortion were calculated by compiling rates of hospital admissions in 13 countries in the developing world and studying data from a further five countries in sub-Saharan Africa....

Political commitment to reducing maternal mortality: Tanzania.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... The number of women who died during pregnancy, childbirth or after delivery in Tanzania increased rapidly between 1990 and 2000. Lack of resources, poor transport and poverty mean that women who would like to deliver with a skilled attendant...

Leaders from 10 African countries call for safe, legal abortion.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... Political leaders from Botswana, Burkina Faso, Ethiopia, Ghana, Malawi, Mozambique, Tanzania, Uganda and Zambia called for the legalisation of safe abortion procedures in an effort to curb maternal mortality among African women. Of the 68,000...

Risk reduction for illegal abortion, Uruguay.(ROUND UP: Maternal Mortality and Morbidity)
November 1, 2007... Complications of abortion cause 29% of all maternal deaths in Uruguay, compared to worldwide figures of 13%. In one public hospital in Montevideo, unsafe abortion was causing 48% of all maternal mortality, which led a group of...

Using budget analysis to improve maternal health, Mexico.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... By analysing information about government programmes, policies and budgets related to maternal health from the Ministry of Health and Mexican Congress, the Fundar Center for Analysis and Research in Mexico has identified a gap between the...

Strategies to reduce maternal deaths in Jamaica.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... In 1993 a strategy was implemented to reduce deaths from hypertensive disorders of pregnancy in Jamaica, where they had historically been the leading cause of maternal death. Since 1998 all maternal deaths have been reported to the Ministry of...

Village "doctors" most likely to make timely referrals in Bangladesh.(ROUND UP: Maternal Mortality and Morbidity)
November 1, 2007... Timely referral to professional facilities has been widely recognised as essential to reducing maternal mortality. The authors of this research sought to identify whether specific categories of non-medical community practitioners were more...

Medical costs prevent pregnant Bangladeshi women with serious complications from seeking treatment.(ROUND UP: Maternal Mortality and Morbidity)
November 1, 2007... A national survey of 40,000 women giving birth from 1998-2001 has found that almost half (48%) of Bangladeshi women giving birth in 2001 reported receiving antenatal care, a continuation of the rising trend seen from 30% in 1996 and 35% in...

Training in simple interventions for TBAs reduces infant mortality in India.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... SEARCH (Society for Education, Action and Research in Community Health) Maharashtra, India, has developed a model of care for women in rural India that has inspired similar projects across the region and in Africa. Nearly 50% of women in India...

Birthing practices in Thailand.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... Midwives in Thailand are divided into two groups, those providing antenatal and postnatal care in community health centres and those providing care in hospital settings. Most community-based health centres have no facilities for delivery so...

Court victory for advocates of pregnant drug-using women in New Mexico, USA.(ROUND UP: Maternal Mortality and Morbidity)
November 1, 2007... The New Mexico Supreme Court in the USA has confirmed that legislation intended to protect children should not be used to criminalise pregnant women. It upheld an appeal court ruling that overturned the conviction of a pregnant woman who was...

Decision aids for mode of delivery.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... Pregnant women with a previous caesarean section must decide between planned vaginal birth and elective repeat caesarean section. To arrive at similar decisions, non-medical people benefit from decision aids, which help them understand and...

Insurers and midwives collaborate to reduce referrals in Netherlands.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... A contract between Dutch health insurers and the national Organisation of Midwives has been criticised by obstetricians and gynaecologists. The contract sets targets to reduce breech presentations at birth in order to decrease the costs...

Hospitalisation of HIV positive pregnant women in USA before and after highly active antiretroviral therapy.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... A comparison of rates of hospitalisation for selected morbidities among HW positive and negative pregnant women in the USA used data from the 1994-2003 Nationwide Inpatient Sample, descriptive statistics and multivariate logistic regression to...

Antiretroviral therapy in HIV positive pregnant women and risk of pre-eclampsia, fetal death, preterm birth and low birthweight.(ROUND UP: Maternal Mortality and Morbidity)(Human immunodeficiency virus)
November 1, 2007... A study in Spain compared the occurrence of pre-eclampsia or fetal death in women who delivered after at least 22 weeks of pregnancy and in HIV positive women. In 2001, 2002 and 2003, the rates per 1,000 deliveries of pre-eclampsia and fetal...

Infant feeding, HIV and causes of infant death in Botswana.(ROUND UP: Maternal Mortality and Morbidity)(Brief article)
November 1, 2007... A randomised trial in Botswana found that more infants exposed to HIV through breastfeeding survived than infants given formula milk from birth. Gains from reduced HW transmission in formula-fed infants were lost through a greatly increased...

PMTCT programmes: participation and adherence.(ROUND UP: Maternal Mortality and Morbidity)(prevention of mother-to-child-transmission)
November 1, 2007... In rural Malawi. 75 HIV positive pregnant women were registered in a programme for prevention of mother-to-child-transmission (PMTCT) of HIV. Forty of them delivered in hospital and 35 at home. 27 of the women giving birth at home were traced;...

Low rates of mother-to-child HIV transmission through breastmilk of women on antiretroviral therapy.(ROUND UP: Maternal Mortality and Morbidity)(Human immunodeficiency virus )
November 1, 2007... Most efforts for the prevention of mother-to-child transmission of HIV have concentrated on providing antiretroviral therapy around the time of delivery and during the immediate postpartum period to protect the infant. However, up to one-third...

Non-physicians with surgical training carry out most emergency obstetric surgery safely in Mozambique and Malawi *.(ROUND UP: Maternal Mortality and Morbidity)
November 1, 2007... Most medical officers assigned to rural hospitals in Mozambique are recent graduates with very little surgical training and experience, whereas tecnicos de cirurgia (non-physicians performing surgery, TCs) have at least three years of surgical...