Womens Perspective on Use of Services

In focus groups, women listed several factors that prevent them from giving birth in hospitals. They include feelings of embarrassment and fear of the hospital's negative image, the lack of money to pay for transportation and hospital services, bad roads, lack of transport or fear of crime at night, no one to care for their children, and short duration of labor. Facilitators for accessing birth at a hospital include referral by a TBA or health personnel, concerns for safety, complications, and...

Health Nutrition and Population Series

This series is produced by the Health, Nutrition, and Population Family (HNP) of the World Bank's Human Development Network. It provides a vehicle for publishing polished material on the Bank's work in the HNP Sector, for consolidating previous informal publications, and for improving the standard for quality control, peer review, and dissemination of high-quality analytical work. The series focuses on publications that expand our knowledge of HNP policy and strategic issues that can improve...

What Has Happened to Maternal Mortality in Zimbabwe

The demographic and health surveys calculate the MMR based on a direct estimation using the sisterhood method. This looks at time of death (death during pregnancy or within two months postdelivery) without consideration of cause. However, the most likely explanation for the increase in the MMR is a change in the causes of maternal death. Mbizvo reported causes in the 1989-90 community-based studies (Mbizvo and others 1994), based on medical diagnosis or maternal audit 80 percent of maternal...

Links between the Health System and TBAs

Incentives for the TBAs to participate in trainings and to interact with health staff include a medical bag, supplies and their refills, and an identity card that potentially gives them a better reception during referrals at hospitals, according to focus group discussions with TBAs. However, TBAs complained that these expectations were often not met and that the cost of transportation to the monthly meetings was often not reimbursed. Their training in danger signs has resulted in knowledge of...

Bolivia 19962000

Guillermo Seoane, Ramiro Equiluz, Miguel Ugalde, and Juan Carlos Arraya Health care costs in Bolivia were assumed to be a major impediment to the use of services, such as a skilled birth attendant and a hospital for birthing. To overcome this barrier and reduce the MMR of 390 per 100,000 live births (INE and MI 1994), a national health insurance plan has been phased in to cover the costs of services vital to the reduction of maternal and infant mortality. In July 1996 the Bolivian government...

Info

China has reported a large decline in the maternal mortality ratio over three decades, from approximately 1,500 per 100,000 live births in 1950 to 100-200 in rural areas in 1980. Even with replacement of free services, through the cooperative medical system insurance, with fee for service around 1978, the MMR has continued to slowly decline, registering 74 in rural China in 1998 (Ministry of Public Health, or MOPH). Although family planning does not contribute to a reduction in the MMR, China's...

Conclusion Mortality

Using a very targeted approach to reduce one of the primary direct causes of maternal mortality required specific training with frontline providers. It also required training of those who support the midwife, linking the levels of care with a high-risk clinic to manage cases, and linking with the private physicians so that referrals from the private sector increased to 44 percent (the rest of the island is 20 percent). In order to ensure that women themselves knew the danger signs and where to...

Improving Demand

Noting that problems still remained with referral after the first intervention study, MacGillivray went on to develop and test a mother-held card identifying six particular signs and symptoms of hypertension that should be acted upon by immediately going to the health center or local midwife. These were frontal headache, epigastric pain, dimness of vision or seeing spots or flashes, edema, vomiting during the last trimester of pregnancy, and antepartum hemorrhage (another problem for which...

Jamaica 19911995

From 1938 to 1960 the MMR in Jamaica decreased from 600 to 210 per 100,000 live births (Williams 1973). By 1981-83 it had decreased further to 108 (Walker and others 1986), where it essentially remained for the next few years, being reported as 115 in a 1986-87 study (Keeling and others 1991). Between 1981 and 1983, approximately 72 percent of all births occurred in health institutions (Walker and others 1990). In 1986-87, midwives attended 75 percent of deliveries doctors and medical students...

Results

Table 8.1 shows the numbers of cases of antenatal eclampsia in the 10 years from 1986 to 1995. It can be seen that in the control areas, there was an increasing trend for antepartum eclampsia to occur, whereas in the intervention area, starting in 1992, a decrease in eclampsia occurred (p < 0.001). There were no changes in the total number of births in each area that could explain this (McCaw-Binns and others 2000). The total number of admissions per year for hypertensive disorders of...

Acronyms and Abbreviations

AIDS Acquired immune deficiency syndrome BDD Bidan di desa (village-based midwife) bEOC Basic essential obstetric care BHI Basic health insurance (Bolivia) CBD Community-based distributors cEOC Comprehensive essential obstetric care CPR Contraceptive prevalence rate DHS Demographic and health surveys ENESF Encuesta Nacional de Epidemiolog a, Salud, y (National epidemiology and family health survey) ESAP Economic Structural Adjustment Program HIV Human immunodeficiency virus Information,...

Factors Affecting the Reduction of Maternal Mortality

Koblinsky and Oona Campbell Nearly half of all maternal deaths in developing countries occur during labor or delivery, or in the immediate postpartum period. Key factors influencing programs aimed at reducing these deaths are who delivers the woman and where she delivers. A previous review of developing countries that successfully reduced maternal mortality to fewer than 100 deaths per 100,000 live births identified four basic models for implementing delivery care (Koblinsky,...

Access to Emergency Care

Egypt has a well-developed infrastructure of facilities and roads that facilitate access to obstetric care in case of emergency. The country's high population density also means that most women live within close reach of medical facilities. Data from a 1989 survey on availability of services suggest that even in rural areas, 99 percent of women live within 30 kilometers of at least one government hospital (Sayed 1991). Since then there have been improvements in roads and hospital functioning....

The Impact of Insurance on Use of Services

In an evaluation of the MCHI, a study found that there was substantial growth in use of prenatal care and inpatient births, services covered by insurance, compared with use of other services not covered by insurance (see table 5.2) (Dmytraczenko and others n.d.). Prenatal visits increased in public facilities by 39 percent compared with 29 percent for other outpatients, and total births by 50 percent versus 26 percent for other types of inpatients. At the same time, the Table 5.2 Bolivia Growth...

Executive Summary

The stimulus for this study was the question, Can current program strategies reduce maternal mortality more quickly than the decades required in the historically successful countries of Malaysia and Sri Lanka The answer reached after conducting case studies and primary research on safe motherhood programs in seven countries is, no. Once a country reaches a maternal mortality ratio (MMR) of approximately 200, it can reduce its MMR by half within 7 to 10 years, as did Malaysia and Sri Lanka....

Addressing the Major Killer

To address the high rate of eclampsia deaths, health officials developed a pilot project in one parish to ensure that primary care antenatal clinics had clear instructions for referring patients to a high-risk clinic or straight to a hospital. Clear guidelines were also provided for action at the high-risk clinics and referral hospital, detailing when induction of labor should occur and the appropriate treatment for hypertension and preeclampsia. The parish of St. Catherine, with its 7,000...

References

M. Khalifa. 1993. Egypt Maternal and Child Health Survey 1991. Pan Arab Project for Child Development. League of Arab States. Arab Republic of Egypt. CAPMAS. Abdullah, S. A., E. M. Aboloyoun, H. Abdel-Aleem, F. M. Moftah, and S. Ismail. 1992. Maternal Mortality in Assiut. International Journal of Gynecology and Obstetrics 39 197-204. Abdullah, S. A., M. F. Fathalla, A. M. Abdel-Aleem, H. T. Salem, and M. Y. Aly. 1985. Maternal Mortality in Upper Egypt. WHO...