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Lancet. 2007 Apr 14; 369(9569):1240-1243.Every year, 11 million mothers and newborn infants die, and a further 4 million infants are stillborn. Much is known about the efficacy of single interventions to increase survival under well-managed conditions, much less about how to integrate programmes at scale in poor populations. Funds for maternal, neonatal, and child health are limited, and research is needed to clarify the most cost-effective solutions. In 2003, the Bill & Melinda Gates Foundation?s grand challenges in global health focused on scientific and technological solutions to prevent, treat, and cure diseases of the developing world. The disappointing progress towards the Millennium Development Goals (MDGs) 4 and 5 to reduce child and maternal mortality led us to do a similar exercise to engage creative minds from development and health professionals-ie, those who work in the front line-about how research might accelerate progress towards meeting these MDGs. (excerpt)
Food and Nutrition Bulletin. 2003; 24 Suppl 4:S99-S103.Iron deficiency is considered to be one of most prevalent forms of malnutrition, yet there has been a lack of consensus about the nature and magnitude of the health consequences of iron deficiency in populations. This paper presents new estimates of the public health importance of iron-deficiency anemia (IDA), which were made as part of the Global Burden of Disease (GBD) 2000 project. Iron deficiency is considered to contribute to death and disability as a risk factor for maternal and perinatal mortality, and also through its direct contributions to cognitive impairment, decreased work productivity, and death from severe anemia. Based on meta-analysis of observational studies, mortality risk estimates for maternal and perinatal mortality are calculated as the decreased risk in mortality for each 1 g/dl increase in mean pregnancy hemoglobin concentration. On average, globally, 50% of the anemia is assumed to be attributable to iron deficiency. Globally, iron deficiency ranks number 9 among 26 risk factors included in the GBD 2000, and accounts for 841,000 deaths and 35,057,000 disability-adjusted life years lost. Africa and parts of Asia bear 71% of the global mortality burden and 65% of the disability-adjusted life years lost, whereas North America bears 1.4% of the global burden. There is an urgent need to develop effective and sustainable interventions to control iron-deficiency anemia. This will likely not be achieved without substantial involvement of the private sector. (author's)
UN Chronicle. 2005 Dec;  p..Afghan women have one of the world's highest maternal mortality rates. They face many obstacles when it comes to accessing health care: most are rural and do not live close to or cannot access medical facilities, if the need arises. The few existing facilities do not necessarily specialize in obstetric and gynaecological care and cannot always offer quality care. Many Afghan families do not recognize signs of complication during pregnancy and delivery, and may not seek medical attention soon enough to save the lives of mothers and babies. Also ongoing insecurity and cultural norms in the country often keep women from leaving the house to seek urgently needed medical care. Because of cultural pressures, families are reluctant to present women to male doctors, and few female doctors are trained to meet the overwhelming medical needs of women; these conditions constitute a death sentence for thousands of women each year. It is estimated that about 25 per cent of Afghan children die before their fifth birthday from mostly preventable illnesses. The World Health Organization reports that children in Afghanistan are particularly at risk of dying from diarrhoeal diseases that, according to surveys, result in 20 to 40 per cent of all deaths of children under five--an estimated 85,000 children per year. Diarrhoea is also a significant cause of malnutrition, which is a major contributing factor in children's death from other diseases. (excerpt)
Lancet. 2006 Apr 8; 367(9517):1137.Francisco Songane, a former Mozambican health minister who took over as Director of the new Partnership for Maternal, Newborn and Child Health on Feb 1, 2006, is a man with a mission. His goal is to capitalise on emerging political will--after years of neglect by the international community-- to reduce the unacceptably high toll of 11 million women, infants, and children under the age of 5 years who die every year from largely preventable diseases. "Children are dying and mothers are dying", he told The Lancet. "It is not normal to die in childbirth. It is not normal to die as a newborn", he says, commenting that in some countries, such as Mozambique, many women do not name their children for the first month because so many babies die. "We have to change that kind of fatalism. We cannot accept that people who make up two thirds of the world's population are dying silently without anyone helping", Songane asserts. (excerpt)
Geneva, Switzerland, World Health Organization [WHO]. Department of Reproductive Health and Research, 2001. 178 p. (Occasional Paper No. 5)This report considers how human rights laws can be applied to relieve the estimated 1,400 deaths world-wide that occur every day, an annual mortality rate of 515,000, that women suffer because they are pregnant. Human rights principles have long been established in national constitutional and other laws and in regional and international human rights treaties to which nations voluntarily commit themselves. The intention of the report is to facilitate initiatives by governmental agencies, nongovernmental groups and, for instance, international organizations to foster compliance with human rights in order to protect, respect and fulfill women’s rights to safe motherhood. The report outlines how the dimensions of unsafe motherhood can be measured and comprehended, and how causes can be identified by reference to medical, health system and socio-legal factors. It introduces human rights laws by identifying their sources and governmental obligations to implement them, and explains a range of specific human rights that can be applied to advance safe motherhood. The rights are shown to interact with each other, and for purposes of discussion, they are clustered in the following ways: rights to life, survival and security; rights relating to maternity and health; rights to nondiscrimination and due respect for difference; and rights to information and education relevant to women’s health protection during pregnancy and childbirth. The setting of performance standards for monitoring compliance with rights relevant to reproductive health, and availability and use of obstetric services are addressed. In conclusion, the report considers several strategies to encourage professional, institutional and governmental implementation of the various human rights in national and international laws relevant to reduction of unsafe motherhood, and to enable women to go through pregnancy and childbirth safely. (excerpt)
Criteria reaffirmed for broad-spectrum antibiotics and hormonal methods, cervical neoplasia and COCs, breastfeeding and progestins.
In: WHO updates medical eligibility criteria for contraceptives, by Ward Rinehart. Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health Project [INFO], 2004 Aug. 6. (INFO Reports No. 1; USAID Grant No. GPH-A-00-02-00003-00)Case reports have raised suspicions that broad-spectrum antibiotics in general might lower the effectiveness of hormonal contraceptives. Still, studies find that various broad-spectrum antibiotics do not lower hormone levels and, with one early exception, they have found no evidence of ovulation. Pregnancy rates are similar among women taking COCs alone and women taking both COCs and antibiotics. The 2003 Expert Working Group left broadspectrum antibiotics in MEC category 1 (use in any circumstances). The MEC previously categorized use of the antibiotics rifampicin and griseofulvin both as category 3 (not usually recommended) for most hormonal contraceptives because these drugs were thought to reduce contraceptive effectiveness. There are reports of pregnancies in users of hormonal contraceptives taking griseofulvin, and griseofulvin affects liver enzymes in mice, suggesting a possible impact on hormone metabolism. There are no published clinical or pharmacokinetic studies on interaction between griseofulvin and contraceptive hormones, however. The Expert Working Group reclassified use of griseofulvin to category 1 for users of combined or progestin- only injectables and category 2 (generally use) for users of other hormonal methods. (excerpt)
Geneva, Switzerland, WHO, 2004.  p.Every year some eight million women suffer pregnancy-related complications and over half a million die. In developing countries, one woman in 16 may die of pregnancy-related complications compared to one in 2800 in developed countries. Most of these deaths can be averted even where resources are limited but, in order to do so, the right kind of information is needed upon which to base actions. Knowing the statistics on levels of maternal mortality is not enough—we need information that helps us identify what can be done to prevent such unnecessary deaths. Beyond the numbers presents ways of generating this kind of information. The approaches described go beyond just counting deaths to developing an understanding of why they happened and how they can be averted. For example, are women dying because: they are unaware of the need for care, or unaware of the warning signs of problems in pregnancy?; or the services do not exist, or are inaccessible for other reasons, such as distance, cost or sociocultural barriers?; or the care they receive is inadequate or actually harmful? (excerpt)
International Journal of Gynecology and Obstetrics. 2003 Sep; 82(3):357-367.The International Federation of Gynecology and Obstetrics – FIGO – has been striving hard to carefully attend to women’s well-being, and respect and implement their rights, the status and their health, which is well beyond the basic obstetric and gynecological requirement. FIGO is deeply involved in acting as a catalyst for the all-round activities of national obstetric and gynecologic societies to mobilise their members to participate in and contribute to, all of their endeavours. FIGO’s committees strengthen these objectives and FIGO’s alliance with WHO provides a springboard. The task is gigantic, but FIGO, through national obstetric and gynecological societies and with the strength of obstetricians and gynecologists as its battalion, can offer to combat and meet the demands. (author's)
Making safe motherhood a reality in West Africa. Using indicators to programme for results. [Pour que la maternité sans risque devienne une réalité en Afrique de l'Ouest. Le recours à des indicateurs nécessitant d'être développés en vue de l'obtention de résultats]
New York, New York, UNFPA, 2003. 31 p.For too long, maternal mortality reduction efforts stalled, in large part because the facts underlying the problem—and the best strategies to address it—were poorly understood. That is why we are so proud to present this report as the first outcome of a collaborative effort between UNFPA and the Governments of Cameroon, Côte d’Ivoire, Mauritania, Niger and Senegal. This report is a tangible reflection of our determination to address maternal mortality using a strategic and practical evidence- based approach in a region where data has been scarce, and where too many women have died. This document represents the first careful assessment of obstetric services in these five countries using emergency obstetric care process indicators. Process indicators assess the critical emergency obstetric care functions that should be made available to all women experiencing complications of pregnancy. These indicators are sensitive, relatively easy to collect, and therefore suitable for monitoring progress in our collective fight against maternal mortality and morbidity. Most important, they can identify problems and suggest their amelioration within a fairly short period of time. This can help programme managers stay on track and save women’s lives. In the countries surveyed, Ministries of Health collaborated with UNFPA and played leadership roles during national workshops aimed at sharing the assessments with other agencies involved in safe motherhood programmes, including WHO and UNICEF. This kind of collaboration and knowledge sharing is extremely useful for strengthening programmes. It not only ensures full ownership of the process but also spotlights those services that need urgent attention by all partners. Malawi and Morocco, which earlier carried out similar initiatives, contributed to the process by sharing their experiences in collecting and using process indicators at the methodology workshop that launched this project. Since then, word of these studies has spread to other countries, and The Gambia, Gabon and Guinea-Bissau are replicating this exercise, with UNFPA support. This phased approach means we can continue to build on past efforts and to use our resources effectively as we move forward. Our hope is that many other partners will support the respective Governments in their efforts to reduce maternal mortality rates as part of our commitment to the Millennium Development Goals. The Maternal Mortality Update 2002, which is published as a companion piece to this report, documents other efforts of UNFPA to make childbearing safer for women around the world. Together these documents underscore UNFPA’s larger commitment to fulfilling women’s right to life and reproductive health. (excerpt)
Washington, D.C., Global Health Council, 2002 May. 20 p. (Technical Report)This document includes the following chapters: Towards an Evidence-Based Approach to Decision Making; Reducing Maternal Mortality Through Evidence-Based Treatment of Eclampsia; Reducing Postpartum Hemorrhage: Routine Use of Active Management of the Third Stage of Labor; The WHO Reproductive Health Library (RHL) Better Births Initiative: A Programme for Action in Middle- and Low-Income Countries; and Using Evidence to Save the Lives of Mothers.
Amsterdam, Netherlands, WGNRR, 1991. 48 p.This report summarizes the activities of the Women's Global Network for Reproductive Rights (WGNRR), an organization that campaigns to reduce maternal mortality and morbidity, during 1991. In addition to its summary of activities, the report provides examples of local, national, and regional activities which illustrate the efforts of WGNRR's campaign. The report explains that the organization has succeeded in establishing May 28 as the Day of Action for Women's Health. For 1992, WGNRR hopes to make the issue of adolescent mothers the focus of the Day of Action. Having presented excerpts of Martha Rosenberg's paper entitled "Rethinking maternity: a women's task" (presented at the University of Salamanca, Spain on September 1990), the report goes on the describe the work done by WGNRR groups. As an example of a local initiative, the publication discusses the efforts conducted in Tanzania to end sexual harassment. This topic became the focus of the Day of Action. The Tanzania Media Women's Association held a seminar do discuss issues such as rape, media images of women, violence, and harassment in the workplace. The report goes on to describe a national campaign conducted in Chile, a campaign entitled "I am a woman. . . I want to be healthy," which focused on women's demands to humanize health care. For its regional experience, the report discusses accomplishments of the First Regional Workshop on Maternal Mortality, held in Managua in April 1991. The workshop attracted participants from Belize, Costa Rica, the Dominican Republic, Guatemala, Mexico, and Nicaragua. The report also includes an evaluation of the campaign conducted in Lima, Peru. Finally, the report presents excerpts of letters and reports of activities conducted by member groups around the world.
Bangkok, Thailand, WHO/UNESCO AIDS Education and Health Promotion Materials Exchange Centre for Asia and the Pacific, 1990. , 10,  p.A resource booklet for use by Asian and Pacific country AIDS education programs, published on World AIDS Day, 1 December 1990 entitled "AIDS and Women" is made up of a background introduction, a set of 1-page country profiles, and annexes chiefly documents issued by international agencies on AIDS and topics related to women. Women are particularly vulnerable in the oncoming AIDS epidemic both because they are getting infected in higher numbers, and because they bear the burdens of family care, income and food production, caring for the sick, and the personal, social and economic problems resulting from death of a spouse. While women increasingly become infected via heterosexual intercourse, and they must decide whether to become pregnant, they often do not have the power to coerce a partner to use condoms, nor do they have the benefit of literacy or education to deal with the issues. Female education, of in-school and out-of-school women, will help a country's total fertility rate and infant mortality rate, but is more important for controlling AIDS. Each country statistical profile includes demographic and health items such as population, age structure, life expectancy, birth, death and total fertility rate, infant, maternal and under-5 mortality rates, adult female illiteracy rate, expenditure on health and education, and number of reported AIDS cases.
Future generations ready for the world. UNFPA's contribution to the goals of the World Summit for Children.
New York, New York, United Nations Population Fund [UNFPA], 2001. 27 p.This paper summarizes UN Population Fund's (UNFPA) contribution to the goals of the 1990 World Summit for Children. It notes that UNFPA has focused on four major areas of work addressing young people: promoting girls' education, the promotion of adolescent reproductive and sexual health, HIV/AIDS prevention, and the reduction of maternal mortality and morbidity.
[Elsa Zylberstein emphasizes information for safer motherhood] Elsa Zylberstein insiste sur l'information pour une maternite plus sure.
Equilibres et Populations. 2001 May; (68):4.During a trip organized by Equilibres & Population to Senegal and Mali, Elsa Zylberstein, UNFPA ambassador, met with Central and Western African presidents’ wives. Although she already knew about maternal mortality-related problems, Zylberstein began to truly understand them once in Africa visiting field projects conducted by local organizations. Information is essential to improving maternity conditions in Africa. In particular, Mrs. Zylberstein stresses the need to provide young girls with professional training, and encourage the professionalization of midwives. For many maternal mortality- related problems, women and their husbands must be directly convinced of the importance of ensuring mothers’ access to primary healthcare services during pregnancy and motherhood. They must also be convinced that family planning can contribute to their well-being and the fight against maternal mortality involves recognizing women’s status. Following pregnancy, mothers have the right to rest and be cared for. They also have the right to earn personal and familial income. Finally, women also need to learn to respect themselves.
Progress in Reproductive Health Research. 2001; (56):1.Due to the poor implementation of antenatal care programs, women in developing countries are more than 400 times as likely to die from complications during pregnancy as women in southern Europe. To make matters worse, many components of these programs have not been subjected to rigorous scientific evaluation to determine their effectiveness. This lack of "hard" evidence has impeded the optimal allocation of scarce resources in developing countries. Thus, this issue of a bulletin called Progress in Reproductive Health Research provides a comprehensive review of antenatal care research in developing countries conducted by the Special Programme of Research, Development and Research Training in Human Reproduction, a global program of technical cooperation among several UN agencies, WHO and the World Bank. This introductory article explains that the first article in the bulletin is based on a systematic review of what is known about antenatal care and shows why this area has been difficult to study. Then, the major causes of maternal mortality and morbidity are described in the proceeding article. Finally, the next two articles describe the randomized controlled trial for the evaluation of the existing WHO antenatal model and discuss the findings.
SAFE MOTHERHOOD. 1999; (27):3.This article comments on the high rates of maternal and infant mortality. Dr. Gro Harlem Brundtland, Director-General of WHO, asserted that safe motherhood is a matter of economic good sense, and that resources needed to tackle maternal mortality should be seen as an investment, not a cost. She cited three factors that are vital to help solve the problem of maternal and infant mortality: 1) every pregnancy should be wanted; 2) all pregnant women must have access to skilled care; 3) all pregnant women must be able to reach a functioning health care facility when complications arise. She further added that making pregnancy safer is not only a health issue but also a moral issues that involves principles of human rights, social responsibility, equity, and participation. Lastly, she expressed that high levels of maternal mortality reflect the failure of health systems, policies, and programs in addressing the essential needs of women.
International Journal of Gynecology and Obstetrics. 1998 Dec; 63 Suppl 1:S3-12.The introduction to this article, which describes the International Association for Maternal and Neonatal Health (IAMANEH) and the concept of reproductive health, discusses the recent promotion of reproductive health instead of birth control, a conceptual change that has not yet affected a change in the delivery of health care, and the institution of IAMANEH and the Safe Motherhood Initiative. Section 2 sketches the history of this conceptual change from an emphasis on population control in the 1960s to a period of reassessment and change in the 1980s. Section 3 reviews obstacles that impede improvements in women's health in developing countries, and the fourth section focuses on broad definitions of reproductive health and the support for this approach offered by such international institutions as the World Bank and the European Union. Section 5 explains the implications of applying the concept of reproductive health in practice, including creation of the necessary conditions, defining priorities, expanding integrated health services, making all family planning (FP) methods available, educating users and providers to allow an adequate choice of FP, and assuring women's participation in the health system at all levels.
BMJ (CLINICAL RESEARCH ED.). 1998 Apr 11; 316(7138):1113.The World Health Organization (WHO) has reiterated its goal of reducing maternal mortality by 50% by 2000, and celebrated the 10th anniversary of its Safe Motherhood Initiative on April 7. The initiative is a coalition formed by the WHO, UNICEF, the World Bank, the UN Population Fund, and other nongovernmental organizations to encourage countries to look at the position of women in society and improve their health care. About 1600 women die every day due to complications in pregnancy and childbirth, mostly in Asia and Africa. Of all the health statistics monitored by the WHO, maternal mortality is the one with the largest discrepancy between developed and developing countries; the level of maternal mortality in the developing world is almost 18 times higher than that in the developed world and up to one third of all deaths among women of reproductive age in many developing countries are the result of complications of pregnancy or childbirth. The WHO claims that providing care from conception to delivery, including family planning and neonatal care, would cost only about $3 per woman, an important social and economic investment. China, Sri Lanka, Iran, and Cuba have had considerable success in reducing their levels of maternal mortality through a combination of commitment to the initiative and improved health care.
Washington, D.C., American Association for World Health, 1998. 47 p.World Health Day, established by the World Health Organization (WHO), is celebrated on April 7 in the 191 WHO member countries. WHO has designated Safe Motherhood as the common theme for 1998 World Health Day activities. Safe Motherhood is an international initiative aimed at ensuring women have safe pregnancies and deliveries and healthy infants. This manual was prepared as a resource for those involved in the planning of World Health Day 1998 in the US, where the slogan is: "Invest in the Future: Support Safe Motherhood." After providing background information on the global importance of the prevention of maternal mortality and morbidity, the manual sets forth detailed guidelines on forming an organizing committee, selecting events and activities, choosing a location, creating a planning schedule, identifying community resources, defining target audiences, using the mass media to publicize events, hospitality arrangements, and program evaluation. World Health Day activities appropriate for individuals, communities, workplaces, schools, religious organizations, government agencies, and health care settings are suggested. Also included, for possible reproduction, is a series of fact sheets on topics such as pregnancy-related mortality in the US, maternal nutrition, sexually transmitted diseases, family planning, prenatal care, warning signs during pregnancy, and breast feeding. Finally, lists of state contacts and hotlines are appended.
PANORAMA. 1997; 2.Nearly every woman experiences some form of violence during her life, said Mrs. Ingar Brueggemann, Secretary General of the International Planned Parenthood Federation (IPPF), who called on people everywhere to use the occasion of International Women's Day as a catalyst for action to stop violence against women throughout the world. In a widely distributed statement released on that occasion, IPPF warned that violence against women was causing terrible human suffering and was a clear violation of women's basic human rights. Violence against women is gradually gaining the attention it deserves, and IPPF intends to keep up the momentum by raising awareness and pressing for policy and program changes that will allow women to enjoy their fundamental human rights, it was said in the statement. In its message, IPPF drew attention to two issues of particular importance: the harmful practice of female genital mutilation (FGM) and the tradition of forced and early marriage. It was stated that 85-114 million girls and women in the world today are estimated to have undergone FGM. Concerning the tradition of early marriage, it was stated that mothers under the age of 15 years had been found to be seven times more at risk of death during pregnancy and delivery than those who delay childbearing until they reach the age of 20 years. Children born to mothers aged 15-19 years face a 30% greater chance of dying than those born to mothers aged 20 years and older, the press release concluded. (full text modified)
MUSLIM. SUNDAY MAGAZINE. 1997 Mar 30; 7.Each year more than 500,000 women die of pregnancy-related causes in developing countries, and 120 million who wish to limit their family size lack the means to do so. In addition, 20 million unsafe abortions take place every year, 15 million adolescents give birth, and 300 new cases of sexually transmitted disease occur. As many as 40 million people may be infected with HIV by the year 2000. Pakistan has a high maternal mortality rate, a high fertility rate, a high growth rate, and a low rate of contraceptive prevalence. Maternal mortality can be reduced if women avoid having too many babies and avoid having them too close, too early, and too late in their lives. In Pakistan, the International Planned Parenthood Federation is working to provide family planning (FP) services and has endorsed the concept of reproductive health. Reproductive health services include quality FP, maternal care, immunization, prevention and treatment of sexually transmitted diseases and HIV/AIDS, management of complications from unsafe abortion, IEC (information, education, and communication) about sexual and reproductive health, and referral for conditions such as cancer and infertility. Reproductive health rights are included in the Human Rights Charter, which protects the rights to life, to liberty and security of the person, to equality and freedom from discrimination, to privacy, to freedom of thought, to information and education, to choose whether or not to marry and to found a family, to decide whether or when to have children, to health care, to benefit from scientific progress, to freedom of assembly and political participation, and to be free from torture or inhuman treatment. Reproductive health services should be linked to general health services and should receive special funding. The status of women and girl children should also be improved.
WORLD HEALTH STATISTICS QUARTERLY. RAPPORT TRIMESTRIEL DE STATISTIQUES SANITAIRES MONDIALES. 1996; 49(2):74-6.This article is the introduction to a special journal issue devoted to themes concerning women's health security. A great deal of information about women's health and about ways to solve health problems is now available, and women's overall health and well-being have improved. Health must be considered in a holistic fashion that embraces a lifespan perspective. More needs to be done to reduce violence against women, improve maternal morbidity and mortality, and protect women from increasing HIV transmission. 20-50% of women worldwide have been beaten by a male partner. Women and children make up the majority of civilian victims of violent conflict and refugee situations. Pregnancy complications kill 1 woman in 50 in developing countries, compared to 1 woman in 8,000 in developed countries. Approximately one-third of all women in developing countries suffer at some time in their lives from maternal morbidity or disability, including uterine prolapse, reproductive tract infections, chronic anemia, and obstetric fistula. In 1995, almost half of new cases of HIV infection worldwide were women. The World Health Organization and the Global Commission on Women's Health are organizations committed to improving women's health security. Health care throughout the entire lifespan is a universal human right. Guaranteeing women the right to be free from violence, to education, to safe motherhood, to protection from HIV/AIDS, and to gender-sensitive interventions is a responsibility that can be met by advocacy as well as by concrete actions.
MODERN MIDWIFE. 1996 Sep; 6(9):10-3.Maternal mortality rates in developing countries are higher than previously estimated and exceed 1000/100,000 live births in approximately 21 developing countries. While conditions of war increase maternal deaths, the leading direct causes are hemorrhage, sepsis, obstructed labor, eclampsia, and abortion. The World Health Organization (WHO) has prepared a video on the topic that states that nobody knows the extent of the problem of maternal mortality, nobody cares enough to ensure that women's needs are met, and nobody prepares, because not enough people understand the need to prepare for a healthy pregnancy and birth or how to respond to an obstetric emergency. The WHO has identified "gatekeepers" at every level to family planning, prenatal care, clean and safe delivery, and essential obstetric care, and it has created a series of midwifery education modules to promote safe motherhood. Conditions of poverty and low status for women are the prime indirect causes of maternal mortality and maternal morbidity (which is compounded in developing countries by inaccessible or unaffordable health care). Activities to improve this situation include the provision of obstetric supply packs to families, birth spacing programs, discouragement of female genital mutilation and early marriage, use of a picture card or drama and song to illustrate maternal complications, improved postabortion care, international study for midwife teachers, establishment of maternity waiting homes near hospitals, and use of the radio for health education.
ANNUAL REVIEW OF PUBLIC HEALTH. 1996; 17:359-82.This overview describes current growth in the population of the world as well as the momentum which keeps populations expanding even after fertility rates decline. This background information precedes a discussion of the 1994 International Conference on Population and Development (ICPD) which includes the preparatory activities, the position of the ICPD in the context of previous decennial population conferences, major innovations included in the Program of Action, and the process used to reach consensus. The following six major reproductive health concerns which arose from the ICPD are then considered: gender inequality; access to contraceptive services; sexually transmitted disease (including HIV/AIDS) prevalence, health effects, and programmatic effects; maternal mortality; unsafe abortion; and adolescent pregnancy. It is concluded that the ICPD was of enormous significance because it managed to gain consensus on some of the most controversial topics in the area of reproductive health and to mirror some of the most pressing population problems of the decade. The major drawback of the Program of Action is seen as the fact that its success will depend upon the political and financial will of governments.
Geneva, Switzerland, WHO, 1994. , 76 p. (WHO/FHE/MSM/94.18)Staff of the WHO Maternal Health and Safe Motherhood (MSM) Programme and the Special Programme of Research, Development and Research Training in Human Reproduction reviewed MSM research to help the MS Scientific and Technical Advisory Group determine at its March-April 1993 meeting future directions of MSM's research component. The review's report includes an overview of MSM and its protocols and funding. The section on research results addresses maternal mortality studies (epidemiologic, social/behavioral, and intervention/prevention studies), maternal morbidity, hemorrhage, anemia, hypertensive disorders of pregnancy, infections, obstructed labor, and abortion. The programmatic analysis of MSM research examines methodology, characteristics of funded studies, monitoring the progress of studies, and documents resulting from MSM research. Sections on technical working groups and a discussion follows. Staff concluded that high priority issues revolve around the most common complications of pregnancy and the most frequent causes of maternal death: postpartum hemorrhage, anemia, puerperal infection, eclampsia, and obstructed labor. New scientific knowledge from MSM research includes stability of various oxytocic preparations, value of 10 IU of oxytocin after delivery in prevention of postpartum hemorrhage, and the value of the partograph in reducing complications related to prolonged and obstructed labor. MSM research activities have been important catalysts in improving maternal health in many developing countries. Based on this review, the staff recommends that MSM become more proactive, focus on high priority areas, conduct multicenter studies, and continue to support investigator-initiated proposals to facilitate national research. The annexes include completed research results, summary of ongoing studies, follow-up activities of MSM supported maternal mortality projects, and reports and articles arising out of MSM supported research. The report concludes with abstracts of MSM research.