4,381 results
Search Results
2. Understanding the relationship between social determinants of health and maternal mortality: Scientific Impact Paper No. 67.
- Author
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Jones GL, Mitchell CA, Hirst JE, and Anumba DOC
- Subjects
- Female, Gender Identity, Humans, Infant, Newborn, Male, Pregnancy, Social Determinants of Health, Women's Health, Maternal Health Services, Maternal Mortality
- Abstract
Within this document we use the terms pregnant woman and women's health. However, it is important to acknowledge that it is not only people who identify as women for whom it is necessary to access care. Obstetric and gynaecology services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth., (© 2022 Royal College of Obstetricians and Gynaecologists.)
- Published
- 2022
- Full Text
- View/download PDF
3. Assessing cardiovascular disease risk in women with a history of hypertensive disorders of pregnancy: A guidance paper for studies using administrative data.
- Author
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Johnston, Amy, Smith, Graeme N., Tanuseputro, Peter, Coutinho, Thais, and Edwards, Jodi D.
- Subjects
- *
CARDIOVASCULAR diseases , *PREGNANCY , *CARDIOVASCULAR diseases risk factors , *PREECLAMPSIA , *HYPERTENSION , *RESEARCH questions , *PREGNANCY tests , *MATERNAL mortality - Abstract
Background: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality, and their association with increased cardiovascular disease (CVD) risk represents a major public health concern. However, assessing CVD risk in women with a history of these conditions presents unique challenges, especially when studies are carried out using routinely collected data. Objectives: To summarise and describe key challenges related to the design and conduct of administrative studies assessing CVD risk in women with a history of HDP and provide concrete recommendations for addressing them in future research. Methods: This is a methodological guidance paper. Results: Several conceptual and methodological factors related to the data‐generating mechanism and study conceptualisation, design/data management and analysis, as well as the interpretation and reporting of study findings should be considered and addressed when designing and carrying out administrative studies on this topic. Researchers should develop an a priori conceptual framework within which the research question is articulated, important study variables are identified and their interrelationships are carefully considered. Conclusions: To advance our understanding of CVD risk in women with a history of HDP, future studies should carefully consider and address the conceptual and methodological considerations outlined in this guidance paper. In highlighting these challenges, and providing specific recommendations for how to address them, our goal is to improve the quality of research carried out on this topic. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
4. Maternal Mortality: A National Institutes of Health Pathways to Prevention Panel Report.
- Author
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Davidson KW, Terry MB, Braveman P, Reis PJ, Timmermans S, and Epling JW Jr
- Subjects
- Female, United States epidemiology, Humans, Consensus, Evidence-Based Medicine, Maternal Health, Maternal Mortality, National Institutes of Health (U.S.)
- Abstract
The National Institutes of Health's (NIH) Pathways to Prevention panel on postpartum health provides a consensus statement on the evidence, research gaps, and future priorities to prevent maternal morbidity and mortality. The panel reviewed an NIH-commissioned evidence review and workshop that included epidemiologic studies, demonstration interventions, and other maternal morbidity and mortality research to create these national recommendations. The panel concludes that a maternal morbidity and mortality crisis reflects a systemic failure of current U.S. health care, research efforts, and social policies. The panel recommends improving maternal health through a "maternal morbidity and mortality prevention moonshot" that adopts a comprehensive, multilevel life course conceptual framework; strengthens the research methods used within the science of maternal health; establishes and conducts national prevention, treatment, and policy interventions; and reimburses evidence-informed clinical approaches to improve maternal health across the life course. Without a national focus on fundamentally transformative interventions and other initiatives aimed at redressing structural racism and inequities in health care, current interventions and clinical advances in maternal morbidity and mortality prevention will remain tragically insufficient., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2024
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5. Overcoming the constraints of competitive clientelism? Explaining the success of Ghana's poorest region in reducing maternal mortality.
- Author
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Abdulai AG
- Subjects
- Female, Humans, Pregnancy, Ghana epidemiology, Maternal Health, Delivery of Health Care, Maternal Mortality, Maternal Health Services
- Abstract
Maternal mortality remains a health challenge that many developing countries struggle to address. Drawing on 64 key informant interviews, this article shows how Ghana's most impoverished administrative region, the Upper East, emerged as a bureaucratic 'pocket of effectiveness' in reducing maternal mortality in a context where national political settlement dynamics are undermining progress in improving maternal health. At the national level, Ghana's progress in reducing maternal mortality has been disappointing because public investments are disproportionately directed to reforms that contribute to the short-term political survival of ruling elites. Competitive electoral pressures have contributed to greater elite commitment towards health sector investments with visual impact, while weakening elite incentives for dedicating resources to interventions that are necessary for enhancing the quality of health. The relatively better performance of the Upper East Region in reducing maternal mortality has been driven by a hybrid form of accountability that combines top-down pressures from the regional health directorate with horizontal forms of accountability that result in a competitive spirit among health workers. These findings show that even in contexts where resources are limited, the capacity of sub-national leaders in devising local solutions to local problems can lead to improved performance of health systems at the sub-national level. The findings also suggest the need for academic debates to go beyond the binary distinctions regarding the usefulness of top-down versus bottom-up accountability measures and focus on building effective and legitimate forms of accountability that run both top-down and bottom-up when seeking to improve health service delivery., (© 2023 John Wiley & Sons Ltd.)
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- 2024
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6. Mapping the intersection of social determinants of health, postpartum visit attendance, and pregnancy-related deaths: A scoping review.
- Author
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Ware KS, Thompson C, Renfroe K, Grabowsky A, Onuorah PO, and Williams CH
- Subjects
- Humans, Female, Pregnancy, United States, Health Services Accessibility, Maternal Health Services, Adult, Postpartum Period, Social Determinants of Health, Postnatal Care, Maternal Mortality
- Abstract
Background: Maternal health outcomes in the United States raises concern due to elevated rates of pregnancy-related deaths compared to other developed and underdeveloped countries. This scoping review explores relationships between social determinants of health (SDOH), postpartum visit attendance, and pregnancy-related deaths., Methods: Utilizing the Arksey and O'Malley framework and PRISMA-Scr guidelines, a systematic review was conducted to identify pertinent literature., Results: Eight studies were analyzed, providing insights into SDOH, postpartum visits, and pregnancy-related deaths. The findings highlight healthcare access/quality, economic stability, education, and social/community context as influential in postpartum care utilization. Health insurance emerges a key factor for postpartum attendance. In addition, disparities in geographic access to maternity care services were linked to pregnancy-related deaths. Social contextual factors, such as marital status and social support, exhibited varying associations with postpartum visit attendance., Conclusion: While the analyzed studies provided valuable insight, there remains a gap in the literature examining all three key elements: SDOH, postpartum visit attendance, and pregnancy-related deaths. In conclusion, this scoping review highlights the vital role of addressing social determinants in improving maternal health outcomes. Further research is necessary to better inform interventions to reduce pregnancy-related deaths., (© 2024 Wiley Periodicals LLC.)
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- 2024
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7. Understanding the relationship between social determinants of health and maternal mortality: Scientific Impact Paper No. 67
- Author
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Jane Hirst, Georgina Jones, Dilly Anumba, and Caroline Mitchell
- Subjects
Male ,Maternal Mortality ,Pregnancy ,Social Determinants of Health ,Infant, Newborn ,Obstetrics and Gynecology ,Gender Identity ,Humans ,Women's Health ,Female ,Maternal Health Services - Abstract
Within this document we use the terms pregnant woman and women's health. However, it is important to acknowledge that it is not only people who identify as women for whom it is necessary to access care. Obstetric and gynaecology services and delivery of care must therefore be appropriate, inclusive and sensitive to the needs of those individuals whose gender identity does not align with the sex they were assigned at birth.
- Published
- 2022
8. Health insurance coverage and maternal health services in Rwanda: a policy paradox
- Author
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Malik, Manzoor Ahmad and Alemu, Wondimagegnehu
- Published
- 2024
- Full Text
- View/download PDF
9. Recommendations to improve maternal health equity among Black women in "The South": A position paper from the SNRS minority health research interest & implementation group.
- Author
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Eapen, Doncy, Mbango, Catherine, Daniels, Glenda, Mathew Joseph, Nitha, Mary, Annapoorna, Mathews, Nisha, Carr, Kathryn Kravetz, Wells, Cheryl, Suriaga, Armiel, and Saint Fleur, Angeline
- Subjects
MATERNAL health services ,MEDICAL quality control ,HEALTH services accessibility ,MINORITIES ,BLACK people ,WOMEN ,QUALITY assurance ,NURSING research ,PREGNANCY complications ,HEALTH care teams ,PROFESSIONAL associations ,MATERNAL mortality - Abstract
Black women in the United States experience a higher maternal mortality rate compared to other racial groups. The maternal mortality rate among non‐Hispanic Black women is 3.5 times that of non‐Hispanic White women and is higher in the South compared to other regions. The majority of pregnancy‐related deaths in Black women are deemed to be preventable. Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. The Southern Nursing Research Society has put forward this position paper to provide recommendations to improve maternal health equity among Black women. Recommendations for nurses, multidisciplinary healthcare providers, policymakers, and researchers are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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10. Cardiac Disease in Pregnancy*
- Author
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Clark, S. L., Stanley, T. H., editor, and Schafer, P. G., editor
- Published
- 1995
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11. Mortality Patterns in the USSR and Causes of Death: Political Unity and Regional Differentials
- Author
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Blum, Alain and Joyce, Walter, editor
- Published
- 1992
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12. Determinants of maternal healthcare-seeking behaviours in Ghana
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Bawuah, Alex and Ampaw, Samuel
- Published
- 2023
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13. Improving the maternal mortality rate in Lao PDR: 10 years after the publication of the Yang Ye paper in the Nagoya Journal of Medical Science.
- Author
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Junichi Sakamoto
- Subjects
MATERNAL mortality ,PREGNANT women ,PRENATAL care ,ODDS ratio ,MEDICAL care - Abstract
The aim of this study was to identify the socio-demographic characteristics, knowledge, attitude and accessibility factors related to the utilization of antenatal care (ANC) service among pregnant women in the Kham District, Laos. Data for this cross-sectional study were collected in July 2008, using a two-stage cluster sampling strategy from 24 selected villages in the Kham District. A total of 310 married women of reproductive age who had at least one child and had delivered the last child within two years from the date of data collection were interviewed using structured questionnaires. To examine the predictors of ANC utilization, odds ratios (OR) and 95% confidence intervals (CI) were estimated through a logistic regression model. The results showed that about 53.9% of mothers did not receive any ANC service due to the following reasons: no time (93.4%), not necessary (83.8%), feeling embarrassed (74.3%), and living far away from the ANC facility (71.3%). We found that significant predictors of ANC utilization (p-value < 0.05) were: level of education (OR = 6.8, 95% CI = 2.7-16.8), income (OR = 2.6, 95% CI = 1.2-5.7), knowledge (OR = 6.5, 95% CI = 2.4-17.6), attitude (OR = 3.0, 95% CI = 1.3-7.1), distance (OR = 2.9, 95% CI = 1.1-7.6), availability of public transportation (OR = 4.5, 95% CI = 2.0-10.4), cost of transportation (OR = 2.5, 95% CI = 1.1-5.7), and cost of service (OR = 4.6, 95% CI = 2.2-9.6). Our study shows that the utilization of ANC service was very low. Among other factors, limited knowledge, and lack of a good attitude along with misconceptions about ANC services were the major constraints behind this low utilization. Future health care activities should be focusing on improving women's awareness of ANC. ANC staffs should conduct frequent visits to pregnant women until ANC services become easily accessible to them. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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14. Adoption of safe motherhood practices and the moderating role of facilitating conditions
- Author
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Rai, Shashibala and Biswas, Saswata Narayan
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- 2022
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15. Studies from University of Texas Health Science Center Houston Have Provided New Information about Women's Health (Recommendations To Improve Maternal Health Equity Among Black Women In "the South"a Position Paper From the Snrs Minority Health.
- Abstract
Healthy People 2030 directs healthcare providers to advance health equity through societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and healthcare disparities. Keywords: Houston; State:Texas; United States; North and Central America; Health and Medicine; Maternal Mortality; Pregnancy Complications; Women's Health EN Houston State:Texas United States North and Central America Health and Medicine Maternal Mortality Pregnancy Complications Women's Health 577 577 1 09/04/23 20230905 NES 230905 2023 SEP 7 (NewsRx) -- By a News Reporter-Staff News Editor at Women's Health Weekly -- Investigators discuss new findings in Women's Health. [Extracted from the article]
- Published
- 2023
16. Mortality Associated with the Control of Fertility
- Author
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Bongaarts, John, Schearer, Bruce, Tietze, Sarah L., editor, and Lincoln, Richard, editor
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- 1987
- Full Text
- View/download PDF
17. Do health care companies of India fulfil government’s new orientation towards CSR activities : A special consideration towards maternal health
- Author
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Yadav, Shashi Lata, Vishwanath, Babitha, and Patnaik, Debasis
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- 2020
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18. Education in developing countries and reducing maternal mortality: a forgotten piece of the puzzle?
- Author
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Stefanovic V
- Subjects
- Developing Countries, Educational Status, Health Knowledge, Attitudes, Practice, Humans, Professional Role, Female, Maternal Mortality trends, Needs Assessment organization & administration, Needs Assessment standards, Perinatal Care organization & administration, Perinatal Care standards, Perinatology ethics, Perinatology methods
- Abstract
Despite substantial improvement in reducing maternal mortality during the recent decades, we constantly face tragic fact that maternal mortality (especially preventable deaths) is still unacceptably too high, particularly in the developing countries, where 99% of all maternal deaths worldwide occur. Poverty, lack of proper statistics, gender inequality, beliefs and corruption-associated poor governmental policies are just few of the reasons why decline in maternal mortality has not been as sharp as it was wished and expected. Education has not yet been fully recognized as the way out of poverty, improvement of women's role in the society and consequent better perinatal care and consequent lower maternal mortality. Education should be improved on all levels including girls, women and their partners, medical providers, religious and governmental authorities. Teaching the teachers should be also an essential part of global strategy to lower maternal mortality. This paper is mostly a commentary, not a systematic review nor a meta-analysis with the aim to rise attention (again) to the role of different aspects of education in lowering maternal mortality. The International Academy of Perinatal Medicine should play a crucial role in pushing the efforts on this issue as the influential instance that promotes reflection and dialog in perinatal medicine, especially in aspects such as bioethics, the appropriate use of technological advances, and the sociological and humanistic dimensions of this specific problem of huge magnitude. The five concrete steps to achieve these goals are listed and discussed., (© 2021 Walter de Gruyter GmbH, Berlin/Boston.)
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- 2021
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19. Adverse maternal and perinatal pregnancy outcomes related to very advanced maternal age in primigravida and multigravida in the Netherlands: A population-based cohort.
- Author
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Rademaker D, Hukkelhoven CWPM, and van Pampus MG
- Subjects
- Adult, Age Distribution, Cohort Studies, Female, Humans, Infant, Newborn, Middle Aged, Netherlands epidemiology, Pregnancy, Pregnancy Outcome epidemiology, Prevalence, Retrospective Studies, Risk Factors, Gravidity, Infant Health, Maternal Age, Maternal Health, Maternal Mortality, Perinatal Mortality, Pregnancy Complications epidemiology
- Abstract
Introduction: The age at which women give birth is rising steadily in the western world. Advanced maternal age has been associated with adverse pregnancy outcomes. We assessed the association between advanced maternal age and the risk of adverse maternal and perinatal outcome in primigravid and multigravid women., Material and Methods: The study was a population-based cohort study and included women giving birth between January 2000 and December 2018 using data from the Dutch perinatal registration of Perined. Women were divided into age groups. We compared outcomes between women of 40-44, 45-49, and over 50 years old (the study groups) with women of 25-29 years old (reference group), stratified for parity. We employed multivariable regression to correct for possible confounders including methods of conception, multiple pregnancies, ethnicity, and socio-economic status. Our primary outcomes were maternal and perinatal mortality. Secondary outcomes included common maternal and perinatal complications, as well as cesarean section rate., Results: A cohort of 3 700 326 women gave birth during the study period. Of these women, 3.2% were above 40 years of age. Maternal mortality was rare in all groups, but significantly higher in multigravid women over 50 years old. Perinatal mortality was significantly higher in all pregnancies of women over 40 years old, but not for primigravida over 50 years old. The most notable results with the steepest increase were in maternal complications. Both primigravida and multigravida over 40 years old were at a two times higher risk of perinatal mortality, cesarean section, gestational diabetes, hypertensive disorders, and a low Apgar score after 5 minutes. The risk for women over 45 was almost tripled for perinatal mortality and gestational diabetes and six times higher for cesarean section. Women over 50 years old had a seven times higher risk of cesarean section, a four times higher risk of gestational diabetes, postpartum hemorrhage, and neonatal intensive care unit admission, and a 10 times higher risk of hypertensive disorders., Conclusions: The risk of adverse maternal and perinatal outcomes for women over 40 years old surges as age increases. A novel aspect was the consistent increased risks not only for primigravid women but also for multigravida., (© 2021 Nordic Federation of Societies of Obstetrics and Gynecology.)
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- 2021
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20. Gender inequality, reproductive rights and food insecurity in Sub-Saharan Africa – a panel data study
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Tayal, Deeksha
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- 2019
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21. Maternal Mortality Associated with Legal Abortion
- Author
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Tietze, Sara L., Lincoln, Richard, Tietze, Sarah L., editor, and Lincoln, Richard, editor
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- 1987
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22. Maternal mortality and health in the Arab World: A 25-year epidemiological study.
- Author
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Khachfe HH, Sammouri J, Salhab HA, Fares MY, and El-Najjar R
- Subjects
- Arab World, Female, Humans, Maternal Death, Maternal Health, Maternal Mortality
- Abstract
Aim: In this work, we aim to assess the maternal health in terms of maternal mortality ratios and lifetime risk of maternal death in of women in the Arab World., Methods: Data on maternal mortality rates (MMR) and lifetime risk of maternal death (LTR) were extracted from the official databases of the United Nations Children's Fund. Annual Percentage Change was calculated using Joinpoint regression model. Statistical significance among countries was determined using one-way analysis of variance (anova) on spss version 25.0 (IBM SPSS, 2017)., Results: The MMR and LTR significantly decreased in almost all Arab countries. Somalia was found to be the country with the highest burden of MMR, while Gulf countries had the lowest burden., Conclusion: Our study shows a decrease in the MMR and LTR of maternal death in the Arab world. Although there is a decrease in these rates, but continuous research and efforts must be undergone to better develop the health care system in a great number of Arab countries to decrease the burden of maternal deaths., (© 2019 Japan Society of Obstetrics and Gynecology.)
- Published
- 2019
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23. John J. Sciarra Prize Paper Award for 2021.
- Subjects
- *
MIDDLE-income countries , *LOW-income countries , *SCIENTIFIC communication , *MATERNAL mortality - Abstract
This award has been established for the purpose of encouraging investigators, especially young scientists, from low- and middle-income countries to submit their very best clinical research articles for publication in IJGO. The editors of the I International Journal of Gynecology and Obstetrics i (IJGO) are pleased to announce a prize award for the best clinical research paper from a low- or middle-income country published in the IJGO during 2021. IJGO is the official publication of the International Federation of Gynecology and Obstetrics (FIGO), the primary international organization for the specialty of obstetrics and gynecology. [Extracted from the article]
- Published
- 2021
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24. Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment in low- and middle-income countries.
- Author
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Nove, Andrea, Boyce, Martin, Neal, Sarah, Homer, Caroline S. E., Lavender, Tina, Matthews, Zoë, and Downe, Soo
- Subjects
LOW-income countries ,BIRTH rate ,MATERNAL mortality ,NEONATAL mortality ,CESAREAN section - Abstract
Background: Most countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries' (LMICs') midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration. Methods: Using the most recent available data from publicly available global databases for the period 2000–2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality. Results: In LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country. Conclusions: A complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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25. Women Deliver: closing the gap for reproductive and maternal health—call for papers
- Author
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Pamela Das and Richard Horton
- Subjects
media_common.quotation_subject ,Closing (real estate) ,General Medicine ,Global Health ,Maternal Mortality ,Reproductive Health ,Nursing ,Political science ,Humans ,Female ,Maternal Health Services ,Maternal health ,Periodicals as Topic ,media_common - Published
- 2012
26. The effect of health expenditure on selected maternal and child health outcomes in Sub-Saharan Africa
- Author
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Nicholas Ashiabi, Edward Nketiah-Amponsah, and Bernardin Senadza
- Published
- 2016
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27. John J. Sciarra Prize Paper Award for 2020.
- Subjects
- *
AWARDS , *MIDDLE-income countries , *LOW-income countries , *SCIENTIFIC communication , *MATERNAL mortality - Published
- 2020
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28. John J. Sciarra Prize Paper Award for 2020.
- Subjects
- *
AWARDS , *MIDDLE-income countries , *LOW-income countries , *SCIENTIFIC communication , *MATERNAL mortality - Published
- 2020
- Full Text
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29. Accountability for maternal and newborn health: Why measuring and monitoring broader social, political, and health system determinants matters.
- Author
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Requejo, Jennifer, Moran, Allisyn C., and Monet, Jean-Pierre
- Subjects
INFANT health ,MATERNAL health ,MATERNAL mortality ,HEALTH status indicators ,HEALTH policy - Abstract
This article offers four key lessons learned from a set of seven studies undertaken as part of the collection entitled, "Improving Maternal Health Measurement to Support Efforts toward Ending Preventable Maternal Mortality". These papers were aimed at validating ten of the Ending Preventable Maternal Mortality initiative indicators that capture information on distal causes of maternal mortality. These ten indicators were selected through an inclusive consultative process, and the research designs adhere to global recommendations on conducting indicator validation studies. The findings of these papers are timely and relevant given growing recognition of the role of macro-level social, political, and economic factors in maternal and newborn survival. The four key lessons include: 1) Strengthen efforts to capture maternal and newborn health policies to enable global progress assessments while reducing multiple requests to countries for similar data; 2) Monitor indicator "bundles" to understand degree of policy implementation, inconsistencies between laws and practices, and responsiveness of policies to individual and community needs; 3) Promote regular monitoring of a holistic set of human resource metrics to understand how to effectively strengthen the maternal and newborn health workforce; and 4) Develop and disseminate clear guidance for countries on how to assess health system as well as broader social and political determinants of maternal and newborn health. These lessons are consistent with the Kirkland principles of focus, relevance, innovation, equity, global leadership, and country ownership. They stress the value of indicator sets to understand complex phenomenon related to maternal and newborn health, including small groupings of complementary indicators for measuring policy implementation and health workforce issues. They also stress the fundamental ethos that maternal and newborn health indicators should only be tracked if they can drive actions at global, regional, national, or sub-national levels that improve lives. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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30. Comments on "Safe Motherhood in South Asia: Current Status and Strategies for Change".
- Author
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Samad S
- Subjects
- Asia, Behavior, Demography, Developing Countries, Economics, Fertility, Health, Mortality, Population, Population Dynamics, Psychology, Socioeconomic Factors, Attitude, Delivery of Health Care, Education, Health Services Needs and Demand, Maternal Mortality, Maternal Welfare, Population Growth, Women's Rights
- Published
- 1994
31. Programming for safe motherhood: a guide to action.
- Author
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Koblinsky MA, Tinker A, and Daly P
- Subjects
- Delivery, Obstetric standards, Developing Countries, Female, Health Status, Humans, Labor, Obstetric, Maternal Health Services standards, Nutritional Status, Pregnancy, Pregnancy Complications prevention & control, Risk Factors, Socioeconomic Factors, United States epidemiology, Health Policy, Maternal Health Services organization & administration, Maternal Mortality, Pregnancy Complications mortality
- Abstract
The Safe Motherhood Initiative has successfully stimulated much interest in reducing maternal mortality. To accelerate programme implementation, this paper reviews lessons learned from the experience of industrial countries and from demonstration projects in developing countries, and proposes intervention strategies of policy dialogue, improved services and behavioural change. A typological approach with three hypothetical settings from resource poor to resource rich environments is used to address the variability in health behaviours and infrastructure encountered when programming for safe motherhood.
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- 1994
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32. European Board and College of Obstetrics and Gynaecology position statement on maternal mortality surveillance in Europe.
- Author
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Kallianidis AF, Velebil P, Alexander S, Kristufkova A, Savona-Ventura C, Mahmood T, and Mukhopadhyay S
- Subjects
- Humans, Female, Europe epidemiology, Pregnancy, Obstetrics standards, Gynecology standards, Population Surveillance methods, Societies, Medical, Maternal Mortality
- Abstract
Maternal mortality data and review are important indicators of the effectiveness of maternity healthcare systems and an impetus for action. Recently, a rising incidence of maternal mortality in high income countries has been reported. Various publications have raised concern about data collection methods at country level, as this usually relies mainly on national vital statistics. It is therefore essential that the collected data are complete and accurate and conform to international definitions and disease classification. Accurate data and review can only be truly available when an Enhanced Obstetric Surveillance System is in place. EBCOG calls for action by national societies to work closely with their respective ministries of health to ensure that high quality surveillance systems are in place., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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33. Obstetric transition: trends in maternal mortality in Somalia over the last two decades.
- Author
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Aweis A, Osoble AH, Mohamed SA, and Aweis A
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- Humans, Somalia epidemiology, Female, Pregnancy, Adult, Maternal Health Services trends, Maternal Health Services statistics & numerical data, Delivery, Obstetric statistics & numerical data, Delivery, Obstetric mortality, Young Adult, Obstetrics trends, Maternal Mortality trends
- Abstract
Background: This paper sheds light on the trends of the maternal mortality ratio (MMR) and obstetric transition in Somalia over the last two decades., Methods: This is a descriptive study comparing aggregate secondary data from the 2006 Multiple Indicator Cluster Survey and the 2020 Somali Health and Demographic Survey to show the transition., Results: A 44% reduction of the MMR from 1044 to 692 per 100 000 live births was observed comparing the two surveys., Conclusions: Somalia has moved from stage I to stage II of the obstetric transition pathway spectrum and there is optimism that the ongoing strengthening of the health system is paying off., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)
- Published
- 2024
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34. Local government innovation to support the achievement of sustainable development goals: Insights from Sanpiisan innovation in Kota Semarang.
- Author
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Santoso, R. Slamet, Hanani, Retna, Astuti, Retno Sunu, and Djumiarti, Titik
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DIFFUSION of innovations theory ,CHILD mortality ,DIFFUSION of innovations ,MATERNAL mortality ,SUSTAINABLE development ,GOVERNMENT aid ,LOCAL government ,INFANTS - Abstract
Maternal and child health are part of the Sustainable Development Goals (SDGs). Globally, the world is pushing to reduce maternal mortality to below 70 per 100,000 live births and to reduce infant and under-five years old children mortality rate to 12 per 1000 live births by 2030. However, maternal and child mortality rates in Indonesia remain quite high. Indonesia National Survey data show maternal mortality rate in Indonesia is still quite high at 305 per 100,000 population and the child mortality rate is 24 per 1,000 live births. In order to reduce maternal and child mortality rate, Indonesian government implements various policy interventions including by pushing local governments to create policy innovation in maternal and child health. SANPIISAN (Love and Care for Mothers and Children) is an initiative from Health Office of Kota Semarang to create an integrated system to carry out preventive measures to reduce maternal and child mortality rate in Kota Semarang. Given the success of SANPIISAN, this paper examines the mechanisms that sustain the innovation. In order to answer the question, the paper utilizes diffusion of innovation theory to analyse the diffusion and momentum processes of ideas within a specific social system. Methodology of the research is qualitative research and data are derived from interviews with main policy actors in SANPIISAN program (N=10). We argue that the success of SANPIISAN is supported by strong network among innovation adopters. The research contributes to the growing discussion in local policy innovation to support the achievement of SDGs. We conclude that SANPIISAN has proven to be one of the strategic and effective efforts that has significant leverage for the prevention of maternal and child mortality rates in Kota Semarang. Moreover, the program has been acknowledged as one of good practices in local government initiatives to reduce maternal and child mortality rates. [ABSTRACT FROM AUTHOR]
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- 2023
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35. Health services and maternity in Mexico.
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- Abortion, Induced, Americas, Demography, Developing Countries, Economics, Family Characteristics, Family Planning Services, Family Relations, Health, Health Personnel, Health Services Research, Latin America, Mexico, Mortality, North America, Organization and Administration, Parents, Politics, Population, Population Dynamics, Program Evaluation, Socioeconomic Factors, Delivery of Health Care, Evaluation Studies as Topic, Human Rights, Legislation as Topic, Maternal Mortality, Mothers, Philosophy, Physicians, Public Opinion, Quality of Health Care, Women's Rights
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- 1991
36. [Network of researchers on the health aspects of reproduction].
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- Africa, Africa South of the Sahara, Africa, Northern, Africa, Western, Benin, Cote d'Ivoire, Demography, Developing Countries, Economics, Fertility, Health, Mortality, Organization and Administration, Population, Population Dynamics, Senegal, Sexual Behavior, Child Welfare, Congresses as Topic, Health Planning Guidelines, Health Services Needs and Demand, Infant Mortality, Maternal Mortality, Maternal Welfare, Pregnancy in Adolescence, Program Development, Research
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- 1990
37. Pregnancy and neonatal outcomes of <scp>COVID</scp> ‐19: coreporting of common outcomes from <scp>PAN‐COVID</scp> and <scp>AAP‐SONPM</scp> registries
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Susara Blunden, Michelle Vaz, Enrique Gomez-Pomar, Catherine Buck, Jayanta Banerjee, Alexandra Kermack, Mark Chester, Edward Mullins, Nicole Spillane, Stamatina Iliodromiti, Tom Bourne, Christoph Lees, Chidambara Sankara Narayanan, Julia Townson, Aethele Khunda, and Rebecca Playle
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Male ,Perinatal Death ,coronavirus ,SARS‐CoV‐2 ,fetal growth restriction ,0302 clinical medicine ,Pregnancy ,Epidemiology ,Registries ,030212 general & internal medicine ,PAN-COVID investigators and the National Perinatal COVID-19 Registry Study Group ,Pregnancy Complications, Infectious ,Fetal Growth Retardation ,030219 obstetrics & reproductive medicine ,Radiological and Ultrasound Technology ,Obstetrics ,Pregnancy Outcome ,Obstetrics and Gynecology ,General Medicine ,Stillbirth ,Original Papers ,Vaccination ,Maternal Mortality ,Infant, Small for Gestational Age ,outcome ,Premature Birth ,Gestation ,Female ,Maternal death ,medicine.symptom ,preterm delivery ,Adult ,medicine.medical_specialty ,Context (language use) ,Asymptomatic ,03 medical and health sciences ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Obstetrics & Reproductive Medicine ,Pandemics ,perinatal ,Original Paper ,Fetus ,SARS-CoV-2 ,business.industry ,Infant, Newborn ,COVID-19 ,medicine.disease ,Infectious Disease Transmission, Vertical ,United Kingdom ,United States ,Reproductive Medicine ,1114 Paediatrics and Reproductive Medicine ,business - Abstract
Objective Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and Global Pregnancy and Neonatal outcomes in COVID‐19 (PAN‐COVID) study and the American Academy of Pediatrics (AAP) Section on Neonatal–Perinatal Medicine (SONPM) National Perinatal COVID‐19 Registry. Methods This was an analysis of data from the PAN‐COVID registry (1 January to 25 July 2020), which includes pregnancies with suspected or confirmed maternal SARS‐CoV‐2 infection at any stage in pregnancy, and the AAP‐SONPM National Perinatal COVID‐19 registry (4 April to 8 August 2020), which includes pregnancies with positive maternal testing for SARS‐CoV‐2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN‐COVID results are presented overall for pregnancies with suspected or confirmed SARS‐CoV‐2 infection and separately in those with confirmed infection. Results We report on 4005 pregnant women with suspected or confirmed SARS‐CoV‐2 infection (1606 from PAN‐COVID and 2399 from AAP‐SONPM). For obstetric outcomes, in PAN‐COVID overall and in those with confirmed infection in PAN‐COVID and AAP‐SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was preterm (
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- 2021
38. Factors influencing maternal death in Cambodia, Laos, Myanmar, and Vietnam countries: A systematic review.
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Win PP, Hlaing T, and Win HH
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- Humans, Female, Myanmar epidemiology, Cambodia epidemiology, Laos epidemiology, Pregnancy, Vietnam epidemiology, Prenatal Care statistics & numerical data, Maternal Health Services statistics & numerical data, Maternal Mortality, Maternal Death statistics & numerical data
- Abstract
Background: A maternal mortality ratio is a sensitive indicator when comparing the overall maternal health between countries and its very high figure indicates the failure of maternal healthcare efforts. Cambodia, Laos, Myanmar, and Vietnam-CLMV countries are the low-income countries of the South-East Asia region where their maternal mortality ratios are disproportionately high. This systematic review aimed to summarize all possible factors influencing maternal mortality in CLMV countries., Methods: This systematic review applied "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist (2020)", Three key phrases: "Maternal Mortality and Health Outcome", "Maternal Healthcare Interventions" and "CLMV Countries" were used for the literature search. 75 full-text papers were systematically selected from three databases (PubMed, Google Scholar and Hinari). Two stages of data analysis were descriptive analysis of the general information of the included papers and qualitative analysis of key findings., Results: Poor family income, illiteracy, low education levels, living in poor households, and agricultural and unskilled manual job types of mothers contributed to insufficient antenatal care. Maternal factors like non-marital status and sex-associated work were highly associated with induced abortions while being rural women, ethnic minorities, poor maternal knowledge and attitudes, certain social and cultural beliefs and husbands' influences directly contributed to the limitations of maternal healthcare services. Maternal factors that made more contributions to poor maternal healthcare outcomes included lower quintiles of wealth index, maternal smoking and drinking behaviours, early and elderly age at marriage, over 35 years pregnancies, unfavourable birth history, gender-based violence experiences, multigravida and higher parity. Higher unmet needs and lower demands for maternal healthcare services occurred among women living far from healthcare facilities. Regarding the maternal healthcare workforce, the quality and number of healthcare providers, the development of healthcare infrastructures and human resource management policy appeared to be arguable. Concerning maternal healthcare service use, the provisions of mobile and outreach maternal healthcare services were inconvenient and limited., Conclusion: Low utilization rates were due to several supply-side constraints. The results will advance knowledge about maternal healthcare and mortality and provide a valuable summary to policymakers for developing policies and strategies promoting high-quality maternal healthcare., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Win et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2024
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39. Increased utilisation and quality: a focus on inequality and a learning health system approach-explaining Nepal's success in reducing maternal and newborn mortality 2000-2020.
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Sharma S, Campbell OMR, Oswald WE, Adhikari D, Paudel P, Lal B, and Penn-Kekana L
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- Humans, Nepal, Female, Infant, Newborn, Pregnancy, Infant, Healthcare Disparities, Quality of Health Care, Health Services Accessibility, Maternal Mortality trends, Infant Mortality trends, Maternal Health Services
- Abstract
Introduction: Maternal mortality in Nepal dropped from 553 to 186 per 100 000 live births during 2000-2017 (66% decline). Neonatal mortality dropped from 40 to 21 per 1000 live births during 2000-2018 (48% decline). Stillbirths dropped from 28 to 18 per 1000 births during 2000-2019 (34% decline). Nepal outperformed other countries in these mortality improvements when adjusted for economic growth, making Nepal a 'success'. Our study describes mechanisms which contributed to these achievements., Methods: A mixed-method case study was used to identify drivers of mortality decline. Methods used included a literature review, key-informant interviews, focus-group discussions, secondary analysis of datasets, and validation workshops., Results: Despite geographical challenges and periods of political instability, Nepal massively increased the percentage of women delivering in health facilities with skilled birth attendance between 2000 and 2019. Although challenges remain, there was also evidence in improved quality and equity-of-access to antenatal care and childbirth services. The study found policymaking and implementation processes were adaptive, evidence-informed, made use of data and research, and involved participants inside and outside government. There was a consistent focus on reducing inequalities., Conclusion: Policies and programmes Nepal implemented between 2000 and 2020 to improve maternal and newborn health outcomes were not unique. In this paper, we argue that Nepal was able to move rapidly from stage 2 to stage 3 in the mortality transition framework not because of what they did, but how they did it. Despite its achievements, Nepal still faces many challenges in ensuring equal access to quality-care for all women and newborns., Competing Interests: Competing interests: Dr Punya and Dr Bibek are currently employed by the Government of Nepal. Dr Sharma was previously employed there. Their participation and insights have been invaluable to this report., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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40. A tale of two exemplars: the maternal and newborn mortality transitions of two state clusters in India.
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Ram U, Ramesh BM, Blanchard AK, Scott K, Kumar P, Agrawal R, Washington R, and Bhushan H
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- Humans, India epidemiology, Infant, Newborn, Female, Pregnancy, Infant, Health Policy, Maternal Health Services, Socioeconomic Factors, Infant Mortality trends, Maternal Mortality trends
- Abstract
Background: India's progress in reducing maternal and newborn mortality since the 1990s has been exemplary across diverse contexts. This paper examines progress in two state clusters: higher mortality states (HMS) with lower per capita income and lower mortality states (LMS) with higher per capita income., Methods: We characterised state clusters' progress in five characteristics of a mortality transition model (mortality levels, causes, health intervention coverage/equity, fertility and socioeconomic development) and examined health policy and systems changes. We conducted quantitative trend analyses, and qualitative document review, interviews and discussions with national and state experts., Results: Both clusters reduced maternal and neonatal mortality by over two-thirds and half respectively during 2000-2018. Neonatal deaths declined in HMS most on days 3-27, and in LMS on days 0-2. From 2005 to 2018, HMS improved coverage of antenatal care with contents (ANCq), institutional delivery and postnatal care (PNC) by over three-fold. In LMS, ANCq, institutional delivery and PNC rose by 1.4-fold. C-sections among the poorest increased from 1.5% to 7.1% in HMS and 5.6% to 19.4% in LMS.Fewer high-risk births (to mothers <18 or 36+ years, birth interval <2 years, birth order 3+) contributed 15% and 6% to neonatal mortality decline in HMS and LMS, respectively. Socioeconomic development improved in both clusters between 2005 and 2021; HMS saw more rapid increases than LMS in women's literacy (1.5-fold), household electricity (by 2-fold), improved sanitation (3.2-fold) and telephone access (6-fold).India's National (Rural) Health Mission's financial and administrative flexibility allowed states to tailor health system reforms. HMS expanded public health resources and financial schemes, while LMS further improved care at hospitals and among the poorest., Conclusion: Two state clusters in India progressed in different mortality transitions, with efforts to maximise coverage at increasingly advanced levels of healthcare, alongside socioeconomic improvements. The transition model characterises progress and guides further advances in maternal and newborn survival., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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41. Alliance for Innovation on Maternal Health: Evolution of a program to address maternal morbidity and mortality.
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Allen C, Taylor I, and Ushry A
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- Humans, Female, Pregnancy, United States epidemiology, Patient Safety, Program Development, Patient Care Bundles, Maternal Mortality trends, Quality Improvement, Maternal Health Services organization & administration, Maternal Health
- Abstract
The Alliance for Innovation on Maternal Health program is a national investment in promoting safe care for every birth in the United States and lowering rates of preventable maternal mortality and severe maternal morbidity. Through its work with state and jurisdiction-based teams on patient safety bundle implementation, the program supports data-driven quality improvement. This paper details key aspects of the Alliance for Innovation on Maternal Health including patient safety bundles, technical assistance, implementation resource development, data support, and partnerships while providing an overview of the program's evolution, reach, impact, and future opportunities., Competing Interests: Declaration of competing interest The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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42. Tajikistan Country Gender Assessment
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World Bank
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GENDER RELATIONS ,MIGRANT ,EQUAL OPPORTUNITIES ,RURAL DEVELOPMENT ,ELDERLY MEN ,EARLY MARRIAGE ,FEMALE EDUCATION ,EQUAL ACCESS ,EMPLOYMENT ,EARLY MARRIAGES ,EQUALITY OF MEN ,FUTURE GENERATIONS ,GENDER STUDIES ,NATIONAL LEVEL ,INSTITUTIONAL MECHANISMS ,ENTREPRENEURIAL ACTIVITIES ,INFORMAL SECTOR ,ECONOMIC RESOURCES ,SKILL DEVELOPMENT ,INSTITUTIONAL FRAMEWORK ,MOTHER ,FEMALE STUDENTS ,CULTURAL RIGHTS ,BUSINESS DEVELOPMENT ,FERTILITY RATES ,EARNINGS ,INFORMAL SECTOR EMPLOYMENT ,HIV INFECTIONS ,SOCIAL UNREST ,GENDER POLICIES ,PENSIONS ,SHADOW REPORT ,LOW-INCOME COUNTRIES ,INTERNATIONAL FINANCE ,ECONOMIC OPPORTUNITIES ,FERTILITY ,SECONDARY EDUCATION ,IMPORTANT POLICY ,ECONOMIC SITUATION ,ELDERLY ,HEALTH RISKS ,ID ,GENDER AWARENESS ,SOCIAL NORMS ,DELIVERY CARE ,POLICY IMPLICATIONS ,RIGHTS OF WOMEN ,MATERNAL MORTALITY ,WOMEN'S AGENCY ,FINANCIAL CONSTRAINTS ,ELDERLY WOMEN ,LITERACY RATES ,FINANCIAL LITERACY ,FEMALE EMPLOYMENT ,JOINT LIABILITY ,LABOR FORCE PARTICIPATION ,EMPLOYEE ,EMPLOYMENT STATUS ,EDUCATIONAL CHOICES ,INTRAVENOUS DRUG USE ,MALE INVOLVEMENT ,STATE SUPPORT ,YOUNG WOMEN ,LIFE EXPECTANCY ,HUMAN DEVELOPMENT ,NEW BUSINESSES ,ACCESS TO INFORMATION ,PRINCIPLE OF EQUALITY ,DISCRIMINATION AGAINST WOMEN ,ENDOWMENTS ,EQUAL PAY ,SEXUAL INTERCOURSE ,PREGNANCY ,EDUCATION SYSTEM ,HEALTH SYSTEMS ,HOUSEHOLDS ,RESPECT ,CHILDBIRTH ,GENDER-BASED VIOLENCE ,SECONDARY SCHOOL ,BUSINESS WORKSHOPS ,SOCIAL ASSISTANCE ,UNION ,HOUSEHOLD POVERTY ,MIGRANT HOUSEHOLDS ,FINANCIAL RESOURCES ,UNDP ,POLITICAL RIGHTS OF WOMEN ,PUBLIC LIFE ,POLICY RESEARCH WORKING PAPER ,ENROLLMENT ,INTERNATIONAL ORGANIZATION FOR MIGRATION ,TRADITIONAL GENDER ROLES ,VIOLENCE AGAINST WOMEN ,GENDER EQUALITY ,AGRICULTURAL ACTIVITIES ,CORRUPTION ,HIV ,INCLUSION OF WOMEN ,COVID-19 ,FEMALE WORKERS ,MASS MEDIA ,POLITICAL PARTIES ,SECONDARY ENROLMENT ,COUNTRY GENDER ASSESSMENT ,GENDER ROLES ,MARKET ECONOMY ,RURAL WOMEN ,GENDER ,HUSBANDS ,EDUCATED WOMEN ,GENDER GAP ,UNITED NATIONS DEVELOPMENT FUND FOR WOMEN ,STATE POLICY ,NATIONAL DEVELOPMENT ,LEVELS OF EDUCATION ,WOMEN'S VOICE ,ECONOMIC GROWTH ,EMPLOYERS ,GENDER ANALYSES ,CORONAVIRUS ,CHILD HEALTH ,UNICEF ,FAMILIES ,LABOR MIGRATION ,HEALTH SYSTEM ,ROLE OF WOMEN ,UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT ,RURAL HOUSEHOLDS ,GENDER DISPARITIES ,POPULATION GROWTH ,PROMOTING GENDER EQUALITY ,WORKING CONDITIONS ,MIGRANTS ,SEXUAL VIOLENCE ,PANDEMIC IMPACT ,PRODUCTIVITY ,WORLD POPULATION ,CIVIL WAR ,ECONOMIC CRISIS ,LABOUR MARKET ,ENROLMENT RATES ,EQUALITY IN EDUCATION ,DOMESTIC VIOLENCE ,CIVIL SOCIETY ACTORS ,DISEASES ,MICRO-FINANCE ,GENDER DISCRIMINATION ,VICIOUS CYCLE ,PRIMARY EDUCATION ,LIVING STANDARDS ,REPRODUCTIVE ROLES ,ADOLESCENT GIRLS ,GENDER GAPS ,LEGAL ADVICE ,POPULATION STUDY ,SUPPORT FOR WOMEN ,LIVE BIRTHS ,POLITICAL PARTY ,FEMALE ENTREPRENEURSHIP ,PROGRESS ,LACK OF ACCESS ,SAFETY NET ,LABOR MARKET ,LEGAL RIGHTS ,MORTALITY ,EQUAL RIGHTS ,LACK OF FINANCE ,MATERNAL HEALTH ,GENDER WAGE GAP ,GENDER ASSESSMENT ,NUMBER OF WOMEN ,TERTIARY EDUCATION ,HUMAN RIGHTS ,HEALTH SECTOR ,SOCIAL SECURITY ,INFANT ,HUSBAND ,FEMALE ENTREPRENEURS ,ECONOMIC CHARACTERISTICS ,LABOR MIGRANTS ,DEMOGRAPHIC PROFILES ,UNITED NATIONS DEVELOPMENT PROGRAMME ,FEMALE STAFF ,ECONOMIC ACTIVITY ,NATIONAL STRATEGY ,OLD-AGE ,FEMALE POPULATION ,GENDER STEREOTYPES ,WOMAN ,EQUAL WORK ,GENDER SEGREGATION ,REMITTANCES ,LACK OF COLLATERALS ,UNESCO ,HUMAN CAPITAL ,FEMALE LABOR FORCE PARTICIPATION ,SOCIAL DEVELOPMENT ,SEX ,UNITED NATIONS ,POLITICAL DECISION ,AGRICULTURAL SECTOR ,REPRESENTATION OF WOMEN ,MIGRATION ,SOCIAL EXCLUSION ,FORMS OF DISCRIMINATION ,POLICY RESEARCH ,CHILDBEARING ,LIMITED ACCESS ,GENDER ISSUES ,HOUSEHOLD LEVEL ,TERTIARY LEVEL ,JOURNALISTS ,GENDER MAINSTREAMING ,SCHOLARSHIPS ,POLITICAL RIGHTS ,ELIMINATION OF DISCRIMINATION ,INDIVIDUAL ENTREPRENEURS ,LABOR FORCE ,HEALTH SERVICES ,HIV INFECTION ,DISCRIMINATION ,OUTREACH ,DEMOGRAPHIC CHANGES ,RELIGIOUS PRACTICES ,FOCUS GROUP DISCUSSIONS ,EXPENDITURE - Abstract
The aim of this report is to provide a broad overview of the current state of gender equality in Tajikistan. While the Europe and Central Asia (ECA) region traditionally surpassed many other regions in terms of gender equality, this advantage has been eroding in recent decades. Particularly in Tajikistan, concerns have been raised that men and women have unequally born the consequences of economic, political, and social transitions after independence in 1991. The report examines several dimensions of gender equality both quantitatively and qualitatively. Tajikistan has set up a legal framework that enshrines principles of equality and non-discrimination, but better implementation results require continued efforts. Prevailing social norms and patriarchal systems of decision-making limit women s ability to make effective choices be it at home or at work. The paper is structured along the following lines. The first section introduces the idea of agency that will remain an important issue throughout the report. This is followed by an analysis of disparities in human capital endowment, including health and education. Gender gaps in the Tajik labor market and entrepreneurial activities of men and women are discussed in the fourth and fifth section. The final section concludes with some policy recommendations that might be beneficial for discussions among policy-makers, civil society actors, and development partners.
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- 2021
43. Comorbidities, poverty and social vulnerability as risk factors for mortality in pregnant women with confirmed SARS‐CoV ‐2 infection: analysis of 13 062 positive pregnancies including 176 maternal deaths in Mexico
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G Estrada-Gutierrez, José Rafael Villafán-Bernal, Raigam Jafet Martinez-Portilla, J M Solis-Paredes, S. Espino‐y‐Sosa, A. J. Rodriguez-Morales, V. Medina-Jimenez, Liona C. Poon, J. Torres-Torres, and L Rojas-Zepeda
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Adult ,Social Vulnerability ,poverty ,Comorbidity ,Lower risk ,comorbidities ,Cohort Studies ,COVID‐19 ,Pregnancy ,medicine ,Risk of mortality ,Humans ,Radiology, Nuclear Medicine and imaging ,Advanced maternal age ,Social determinants of health ,Prospective Studies ,Pregnancy Complications, Infectious ,Prospective cohort study ,Mexico ,Original Paper ,Radiological and Ultrasound Technology ,business.industry ,Obstetrics and Gynecology ,COVID-19 ,General Medicine ,vaccines ,medicine.disease ,Original Papers ,Maternal Mortality ,Reproductive Medicine ,maternal death ,Relative risk ,Cohort ,Premature Birth ,Maternal death ,Female ,business ,Demography - Abstract
Mortality in pregnancy due to coronavirus disease 2019 (COVID-19) is a current health priority in developing countries. Identification of clinical and sociodemographic risk factors related to mortality in pregnant women with COVID-19 could guide public policy and encourage such women to accept vaccination. We aimed to evaluate the association of comorbidities and socioeconomic determinants with COVID-19-related mortality and severe disease in pregnant women in Mexico.This is an ongoing nationwide prospective cohort study that includes all pregnant women with a positive reverse-transcription quantitative polymerase chain reaction result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from the Mexican National Registry of Coronavirus. The primary outcome was maternal death due to COVID-19. The association of comorbidities and socioeconomic characteristics with maternal death was explored using a log-binomial regression model adjusted for possible confounders.There were 176 (1.35%) maternal deaths due to COVID-19 among 13 062 consecutive SARS-CoV-2-positive pregnant women. Maternal age, as a continuous (adjusted relative risk (aRR), 1.08 (95% CI, 1.05-1.10)) or categorical variable, was associated with maternal death due to COVID-19; women aged 35-39 years (aRR, 3.16 (95% CI, 2.34-4.26)) or 40 years or older (aRR, 4.07 (95% CI, 2.65-6.25)) had a higher risk for mortality, as compared with those aged 35 years. Other clinical risk factors associated with maternal mortality were pre-existing diabetes (aRR, 2.66 (95% CI, 1.65-4.27)), chronic hypertension (aRR, 1.75 (95% CI, 1.02-3.00)) and obesity (aRR, 2.15 (95% CI, 1.46-3.17)). Very high social vulnerability (aRR, 1.88 (95% CI, 1.26-2.80)) and high social vulnerability (aRR, 1.49 (95% CI, 1.04-2.13)) were associated with an increased risk of maternal mortality, while very low social vulnerability was associated with a reduced risk (aRR, 0.47 (95% CI, 0.30-0.73)). Being poor or extremely poor were also risk factors for maternal mortality (aRR, 1.53 (95% CI, 1.09-2.15) and aRR, 1.83 (95% CI, 1.32-2.53), respectively).This study, which comprises the largest prospective consecutive cohort of pregnant women with COVID-19 to date, has confirmed that advanced maternal age, pre-existing diabetes, chronic hypertension, obesity, high social vulnerability and low socioeconomic status are risk factors for COVID-19-related maternal mortality. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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- 2021
44. Selected Abstracts of Papers Presented at the 4th National Conference of Association of Obstetric Anesthesia and the 1st Joint AOA - OASAO (Obstetric Anesthesia Society Asia Oceania) Conference Hyderabad, India, September 16-18, 2011
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LABOR (Obstetrics) ,PREGNANT women ,MATERNAL mortality ,CATASTROPHIC illness ,ANESTHESIA - Abstract
The article presents several abstracts of research papers presented at the fourth National Conference of Association of Obstetric Anesthesia and the Obstetric Anesthesia Society Asia Oceania (OASAO) Conference held in Hyderabad, India, September 16-18, 2011 on topics including labor analgesia of Indian pregnant women, a 10-year retrospective analysis of mortality in critically ill pregnant patients labor analgesia on previous LSCS patient.
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- 2011
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45. Transitioning from the "Three Delays" to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique.
- Author
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Vidler, Marianne, Kinshella, Mai-Lei Woo, Sevene, Esperanca, Lewis, Gwyneth, von Dadelszen, Peter, Bhutta, Zulfiqar, Sevene, Esperança, Macete, Eusébio, Munguambe, Khátia, Sacoor, Charfudin, Vala, Anifa, Boene, Helena, Amose, Felizarda, Pires, Rosa, Nhamirre, Zefanias, Macamo, Marta, Chiaú, Rogério, Matavele, Analisa, Vilanculo, Faustino, and Nhancolo, Ariel
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CONTINUUM of care ,MEDICAL personnel ,HEALTH facilities ,MATERNAL mortality ,MEDICAL quality control - Abstract
Background: The Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance. Methods: The paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial. Results: Qualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care. Conclusions: There is a need to supplement the pioneering "Three Delays Framework" to include focusing on continuity of care and the "Four Critical Connection Points": (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys. Trial registration: NCT01911494, Date Registered 30/07/2013. [ABSTRACT FROM AUTHOR]
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- 2023
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46. John J. Sciarra Prize Paper Award for 2017.
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OBSTETRICS , *MATERNAL mortality , *AWARDS - Published
- 2017
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47. A national cohort study and confidential enquiry to investigate ethnic disparities in maternal mortality
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Philippa Cox, Marian Knight, Rohit Kotnis, Judy Shakespeare, Joanna Girling, Nicola Vousden, Jenny J. Kurinczuk, Mandish Dhanjal, Sara Kenyon, Fiona Cross-Sudworth, Meg Wilkinson, Derek Tuffnell, Kathryn J. Bunch, Anita Banerjee, Jenny Douglas, Roshni Patel, and MBRRACE-UK
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Medicine (General) ,Pregnancy ,medicine.medical_specialty ,Research paper ,Ethnic group ,Declaration ,Disease ,General Medicine ,medicine.disease ,R5-920 ,Maternal Mortality ,Family medicine ,General Data Protection Regulation ,Confidential Enquiry ,Ethnic disparity ,medicine ,Cultural bias ,Confidentiality ,Psychology ,Cause of death - Abstract
Background: Ethnic disparities in maternal mortality were first documented in the UK in the early 2000s but are known to be widening. This project aimed to describe the women who died in the UK during or up to a year after the end of pregnancy, to compare the quality of care received by women from different aggregated ethnic groups, and to identify any structural or cultural biases or discrimination affecting their care. Methods: National surveillance data was used to identify all 1894 women who died during or up to a year after the end of pregnancy between 2009-18 in the UK. Their characteristics and causes of death were described. A Confidential Enquiry was undertaken to describe the quality of care women received, and describe any structural or cultural biases or discrimination identified. Findings: There were no major differences in assessed quality of care, nor in causes of death between women from different aggregated ethnic groups, with cardiovascular disease the leading cause of death in all groups. Multiple areas of bias were identified in the care women received, including lack of nuanced care (notable amongst women from Black aggregated ethnic groups who died), microaggressions (most prominent in the care of women from Asian aggregated ethnic groups who died) and clinical, social and cultural complexity (evident across all ethnic groups). Interpretation: This confidential enquiry suggests that multiple structural and other biases exist in UK maternity care. Further research on the role of microaggressions is warranted. Funding: NIHR Policy Research Programme Declaration of Interests: All authors have completed the ICMJE disclosure form and declare: Marian Knight, Sara Kenyon and Jennifer Kurinczuk received grants from the NIHR PRP in relation to the submitted work. Kathryn Bunch, Nicola Vousden, Anita Banerjee, Philippa Cox, Fiona Cross-Sudworth, Mandish K. Dhanjal, Jenny Douglas, Joanna Girling, Rohit Kotnis, Roshni R. Patel, Judy Shakespeare, Derek Tuffnell and Meg Wilkinson have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. No authors have other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: Identifiable MBRRACE-UK data were collected in England and Wales without consent with approval of the Secretary of State for Health and Social Care under Section 251 of the NHS Act 2006 (15/CAG/0119). Data were collected in Scotland without consent with approval from the Public Benefit and Privacy Panel for Health and Social Care (1920-0131). Identifiable information was not provided from Northern Ireland. The legal basis for this activity is Article 6 (1)(e) and Article 9 (2)(i) under the General Data Protection Regulation.
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- 2022
48. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 10. Summary, cost effectiveness, and policy implications.
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Perry, Henry B., Stollak, Ira, and Valdez, Mario
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HEALTH policy ,WELL-being ,MEDICAL quality control ,RURAL health services ,LIFE expectancy ,COMMUNITY support ,COMMUNITY health services ,BIRTHING centers ,SOCIAL capital ,HUMAN services programs ,SELF-efficacy ,PSYCHOSOCIAL factors ,COST effectiveness ,CHILD health services ,QUALITY assurance ,INDIGENOUS peoples ,PEOPLE with disabilities ,MATERNAL mortality ,HEALTH equity ,HEALTH promotion ,NUTRITIONAL status ,CHILD mortality - Abstract
Background: This is the final of 10 papers that describe the implementation of the Expanded Census-Based, Impact-Oriented Approach (CBIO+) by Curamericas/Guatemala in the Cuchumatanes mountains of the Department of Huehuetenango and its effectiveness in improving the health and well-being of women and children in a population of 98,000 in three municipalities. The CBIO+ Approach consists of three components: the CBIO (Census-Based, Impact-Oriented) Approach, the Care Group Approach, and the Community Birthing Center Approach. Methods: Each of the preceding papers was summarized. An assessment was made regarding the degree to which the initial implementation research hypotheses were confirmed. The total field cost per capita for operation of the Project was calculated. An assessment of the cost-effectiveness of the Project was made based on the estimated impact of the Project, the number of lives saved, and the number of disability-adjusted life years averted. Results: The Project attained a number of notable achievements in terms of expanding the coverage of key maternal and child health interventions, improving the nutritional status of children, reducing the mortality of children and mothers, providing quality care for mothers at the Community Birthing Centers (Casas Maternas Rurales) that integrate traditional midwives (comadronas) into the care of women during childbirth at the birthing centers, as well as empowering women and building social capital in the communities. CBIO+ is an effective and affordable approach that is particularly notable for its capacity to engage communities in the process of improving the health of mothers and children. Overall, there is strong and consistent evidence in support of the research hypotheses. The findings did produce evidence of declines in under-5 and maternal mortality, but they were not as robust as had been hoped. Conclusion: CBIO+ is an approach that has been effective in engaging communities in the process of improving the health of their mothers and children and in reducing health inequities in this marginalized, difficult-to-reach population of Indigenous Maya people. The CBIO+ Approach is cost-effective and merits further development and broader application in Guatemala and beyond. [ABSTRACT FROM AUTHOR]
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- 2023
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49. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 6. Management of pregnancy complications at Community Birthing Centers (Casas Maternas Rurales).
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Olivas, Elijah T., Valdez, Mario, Muffoletto, Barbara, Wallace, Jacqueline, Stollak, Ira, and Perry, Henry B.
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MATERNAL health services ,RURAL health services ,HEALTH services accessibility ,RESEARCH methodology ,BIRTHING centers ,COMMUNITY health services ,ACQUISITION of data ,INTERVIEWING ,PREGNANCY complications ,PSYCHOSOCIAL factors ,MEDICAL referrals ,MEDICAL records ,RESEARCH funding ,DESCRIPTIVE statistics ,INTERPROFESSIONAL relations ,INDIGENOUS peoples ,DECISION making in clinical medicine ,MATERNAL mortality ,CORPORATE culture - Abstract
Background: In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+. Methods: We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff. Results: During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere. Conclusion: The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right. [ABSTRACT FROM AUTHOR]
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- 2023
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50. Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 5. Mortality assessment.
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Perry, Henry B., Stollak, Ira, Llanque, Ramiro, Okari, Annah, Westgate, Carey C., Shindhelm, Alexis, Chou, Victoria B., and Valdez, Mario
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PNEUMONIA-related mortality ,CAUSES of death ,POSTPARTUM hemorrhage ,AUTOPSY ,HOME care services ,RISK assessment ,CHILDBIRTH at home ,CHILD health services ,DESCRIPTIVE statistics ,RESEARCH funding ,MATERNAL mortality ,INFANT mortality ,CHILD mortality - Abstract
Background: The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, implemented the Census-Based, Impact-Oriented Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, this expanded set of approaches is known as CBIO+. This is the fifth of 10 papers in our supplement describing the Project and the effectiveness of the CBIO+ Approach. This paper assesses causes, levels, and risk factors for mortality along with changes in mortality. Methods: The Project maintained Vital Events Registers and conducted verbal autopsies for all deaths of women of reproductive age and under-5 children. Mortality rates and causes of death were derived from these data. To increase the robustness of our findings, we also indirectly estimated mortality decline using the Lives Saved Tool (LiST). Findings: The leading causes of maternal and under-5 mortality were postpartum hemorrhage and pneumonia, respectively. Home births were associated with an eight-fold increased risk of both maternal (p = 0.01) and neonatal (p = 0.00) mortality. The analysis of vital events data indicated that maternal mortality declined from 632 deaths per 100,000 live births in Years 1 and 2 to 257 deaths per 100,000 live birth in Years 3 and 4, a decline of 59.1%. The vital events data revealed no observable decline in neonatal or under-5 mortality. However, the 12–59-month mortality rate declined from 9 deaths per 1000 live births in the first three years of the Project to 2 deaths per 1000 live births in the final year. The LiST model estimated a net decline of 12, 5, and 22% for maternal, neonatal and under-5 mortality, respectively. Conclusion: The baseline maternal mortality ratio is one of the highest in the Western hemisphere. There is strong evidence of a decline in maternal mortality in the Project Area. The evidence of a decline in neonatal and under-5 mortality is less robust. Childhood pneumonia and neonatal conditions were the leading causes of under-5 mortality. Expanding access to evidence-based community-based interventions for (1) prevention of postpartum hemorrhage, (2) home-based neonatal care, and (3) management of childhood pneumonia could help further reduce mortality in the Project Area and in similar areas of Guatemala and beyond. [ABSTRACT FROM AUTHOR]
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- 2023
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