https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673605710485.pdf

4 million neonatal deaths: When? Where? Why?

Too far to walk : maternal mortality in context

PIP: 43 determinants of low birth weight were analyzed from 895 published papers in the English and French literature from 1970-1984 The assessment was limited to singleton births of women living at sea level with no chronic illness; rare factors and complications of pregnancy were excluded The 43 factors were categorized as genetic and constitutional, demographic and psychosocial, obstetric, nutritional, maternal morbidity during pregnancy, toxic exposure and antenatal care The existence and magnitude of a causal effect on birth weight, gestational age, prematurity and intrauterine growth retardation were determined by a set of methodological standards In developed countries, the most important factor was cigarette smoking, followed by nutrition and pre-pregnancy weight In developing countries the major determinants were racial origin, nutrition, low pre-pregnancy weight, short maternal stature, and malaria Pre-pregnancy weight, prior premature birth or miscarriage, diethylstilbestrol exposure and smoking were major determinants of gestational duration, but the majority of prematurity was unexplained in both developed and developing countries There is a need for future research on the effect of maternal work, prenatal care, and certain vitamin and mineral deficiencies on intrauterine growth, and the effect of genital tract infection, prenatal care, maternal employment, stress and anxiety on prematurity

Determinants of low birth weight: Methodological assessment and meta-analysis

https://globalhealth.duke.edu/sites/default/files/event-attachments/2.18_meara.pdf

Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60518-1.pdf

Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5.

MATERNAL MORTALITY-A NEGLECTED TRAGEDY: Where is the M in MCH?

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2004.11.026

The evidence for emergency obstetric care

Hundreds of thousands of women in developing countries die each year from complications of pregnancy, attempted abortion, and childbirth. This article presents a comprehensive and integrated framework for analyzing the cultural, social, economic, behavioral, and biological factors that influence maternal mortality. The development of a comprehensive framework was carried out by reviewing the widely accepted frameworks that have been developed for fertility and child survival, and by reviewing the existing literature on maternal mortality, including the results of research studies and accounts of intervention programs. The principal result of this exercise is the framework itself. One of the main conclusions is that all determinants of maternal mortality (and, hence, all efforts to reduce maternal mortality) must operate through a sequence of only three intermediate outcomes. These efforts must either (1) reduce the likelihood that a woman will become pregnant; (2) reduce the likelihood that a pregnant woman will experience a serious complication of pregnancy or childbirth; or (3) improve the outcomes for women with complications. Several types of interventions are most likely to have substantial and immediate effects on maternal mortality, including family planning programs to prevent pregnancies, safe abortion services to reduce the incidence of complications, and improvements in labor and delivery services to increase the survival of women who do experience complications.

A framework for analyzing the determinants of maternal mortality.

This article briefly capsules some of the thinking about obstacles obstetrics patients encounter on the way to a care facility which is based on over 200 research studies or articles. The bibliography is available on request and not included in the article. Delay in seeking care is presented in 3 ways. The 1st is in the decision to seek care and discussion is presented in Newsletter 35. The 2nd delay is in reaching a facility after the decision is made which is the subject of this article. The 3rd delay is in receiving the needed care and will appear in Newsletter 37. Based on interviews of rural Kenyan women of the 47% intending to deliver in a hospital only 36% actually did so. Distance and unavailability of public transportation in other studies were expressed as obstacles that prevented women from reaching the hospital. There is not systematic documentation in the literature of these types of delays. Consequently programs which identify high risk women for hospital delivery and raising community awareness may be ineffective if there is inaccessibility of the facility. Urban areas have better access to health facilities and there is uneven distribution in rural areas even in developed countries such as Portugal. The example of an equitably distributed health network exists in Cuba. The implications of the shortage of health facilities and health care providers and the uneven distribution are that limited access interferes with usage. The nature of the terrain and the condition of the roads and the actual distances are considerations. Many inhabitants must walk or improvise a means of transportation to reach health care because there is a scarcity of public transportation. The patients condition may deteriorate on the way which makes treatment more difficult provided the patient is still alive upon arrival. An example is given of a Tanzanian women bleeding to death waiting for a taxi. A decision to seek care may be timely but impaired access prevented utilization. An additional complication is a situation where the nearest facility is not equipped to treat the condition or even administer essential first aid. A further delay occurs in transporting the patient to the proper facility. Death enroute data is scarce and may be included in home deaths but maternal mortality study data is available.

Deborah Maine

Papers

Too far to walk : maternal mortality in context

MATERNAL MORTALITY-A NEGLECTED TRAGEDY: Where is the M in MCH?

The evidence for emergency obstetric care

A framework for analyzing the determinants of maternal mortality.

Too far to walk: maternal mortality in context.