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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)
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)
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.
Measuring reproductive morbidity. Report of a Technical Working Group, Geneva, 30 August - 1 September 1989.
[Unpublished] 1990. 41 p. (WHO/MCH/90.4; Safe Motherhood; UNFPA Project No. INT/88/P14)Reproduction morbidity is defined as any morbidity or dysfunction of the reproductive tract. Obstetric morbidity is related to pregnancy. Direct obstetric morbidity results from obstetric complications of pregnancy, such as ante- or postpartum hemorrhage, eclampsia, or sepsis. Indirect obstetric morbidity results from preexisting diseases, such as malaria, hepatitis, and tuberculosis. Psychological obstetric morbidity includes puerperal psychoses, or fear of pregnancy and childbirth. Direct gynecological morbidity includes reproductive cancers and bacterial or viral sexually transmitted diseases (STDs). Indirect gynecological morbidity includes traditional practices, such as circumcision. Psychological morbidity is associated with STDs, infertility, and dyspareunia. Contraceptive morbidity involves efforts that limit fertility. Some aspects of reproductive morbidity have been covered extensively (e.g., STDs), while studies of uterine prolapse, fistulas, urinary/fecal incontinence, and secondary infertility are few. In a study in India 92% of women had a gynecological problem upon examination, but only 55% reported it. Language is a major impediment to communication because of euphemisms used to describe an ailment. Morbidities tend to be underreported. In a sample of Egyptian women asked about specific problems, backache (47%), abdominal pain (42%), discharge (41%), prolapse (30%), and urinary tract infections (24%) were most common. Hospital studies are used most often to research maternal morbidity followed by community studies, cross-sectional surveys, and case-control studies with proper sample size. The validity of self-reported data greatly depend on the interviewer, but recall bias also has to be considered. It is recommended that WHO sponsor research into reproductive morbidity, develop standardized questionnaires, study a community-based health project, develop a series of "case histories," and plan a meeting during 1990-91.
Plan of action for the eradication of harmful traditional practices affecting the health of women and children in Africa.
[Unpublished] 1987. 14 p.The traditional and harmful practices such as early marriage and pregnancy, female circumcision, nutritional taboos, inadequate child spacing, and unprotected delivery continue to be the reality for women in many African nations. These harmful traditional practices frequently result in permanent physical, psychological, and emotional changes for women, at times even death, yet little progress has been realized in abolishing these practices. At the Regional Seminar of the Inter-African Committee on Traditional Practices Affecting the Health of Women and Children in Africa, held in Ethiopia during April 1987, guidelines were drawn by which national governments and local bodies along with international and regional organizations might take action to protect women from these unnecessary hazardous traditional practices. These guidelines constitute this "Plan of Action for the Eradication of Harmful Traditional Practices Affecting the Health of Women and Children in Africa." The plan should be implemented within a decade. These guidelines include both shortterm and longterm strategies. Actions to be taken in terms of the organizational machinery are outlined, covering both the national and regional levels and including special support and the use of the mass media. Guidelines are included for action to be taken in regard to childhood marriage and early pregnancy. These cover the areas of education -- both formal and nonformal -- measures to improve socioeconomic status and health, and enacting laws against childhood marriage and rape. In the area of female circumcision, the short term goal is to create awareness of the adverse medical, psychological, social and economic implications of female circumcision. The time frame for this goal is 24 months. The longterm goal is to eradicate female circumcision by 2000 and to restore dignity and respect to women and to raise their status in society. Also outlined are actions to be taken in terms of food prohibitions which affect mostly women and children, child spacing and delivery practices, and legislative and administrative measures. Women in the African region have a critical role to play both in the development of their countries and in the solution of problems arising from the practice of harmful traditions.
IPPF OPEN FILE. 1992 Jun; 1.On may 8, 1992, IPPF's Western Hemisphere Regional Office exhibited, at UN headquarters in New York City, 500,000 flowers representing the same number of women who die each year from pregnancy complications. Indeed 99% of these maternal deaths occurred in developing countries, especially Africa. 50 UN ambassadors and representatives attended this event which was endorsed by 40 health and development organizations. Film celebrity Lauren Hutton also attended to show her support. IPPF hoped this event would bring attention to the ongoing need to reduce unwanted pregnancy by providing family planning information and services. The Regional Director of IPPF noted that family planning is the most cost effective means to do so. The Regional Office's Programme Support Director also emphasized the need for trained birth attendants, emergency obstetric care, and proper nutrition. In 1990, the number of unwanted births was about 30 million. For each maternal death, 10-15 women are disabled during childbirth and 25 million pregnant women face serious childbirth complications. A World Bank study showed that if governments would invest just US$1.50/person/year to include prenatal care and family planning into primary health care programs, maternal deaths would fall considerably within 10 years. This amount had been invested during the last 15 years, IPPF would have only needed to display 167,000 flowers. If governments do not take action soon, IPPF will need to display 650,000 flowers in 2000. The Western Hemisphere Regional Office of IPPF has therefore established the Planned Motherhood Fund to expand and strengthen family planning and appropriate health services for women at highest risk of pregnancy-related death, especially teenagers and women in rural areas and urban slums.
[Unpublished] 1991. Presented at the 119th Annual Meeting of the American Public Health Association [APHA], Atlanta, Georgia, November 11-14, 1991. 7,  p.Maternal health affects child survival in many ways. For example, and infant in Bangladesh whose mother has died during childbirth has a 95% chance of dying in the 1st year. Further children <10 years old in Bangladesh, especially girls, who have lost their mother are 4 times as likely to also die. In addition, there is a relationship between protein energy malnutrition in mothers and low prepregnancy weight and meager wait gain during pregnancy which retards fetal growth resulting in a low birth weight (LBW) infant, LBW infants die at a rate 30 times that of adequate weight infants. In fact, child survival depends on maternal health even before the mother is able to conceive. Daughter as well as mothers in developing countries often eat last and smaller amounts of food than male family members. Females who remain poorly nourished often experience obstructed labor which causes several complications for the infant such as respiratory failure. Maternal infections such as malaria and sexually transmitted diseases are also closely linked to LBW. Some can also bring about preterm birth and congenital infections. Pregnancy and labor complications are responsible for about 500,000 maternal deaths annually. Hemorrhage, sepsis, eclampsia, and obstructed labor cause most of these deaths. A woman's fertility pattern also contributes to child survival. The high risk birth categories include too young, too old, too many children, and too closely spaced. In fact, the median mortality rate for infants born <2 years after the older sibling is 71% greater than that for those born 2-3 years apart. The World Bank recommends improved community based health care, improved referral facilities, and an alarm and transport system to improve maternal health. The World Bank, UNDP, UNFPA, UNICEF, WHO, IPPF, and the Population Council support the Safe Motherhood Initiative which aims to reduce maternal morbidity and death by 50% by 2000.
International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations. Jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989.
[Unpublished] 1991. , 64 p.The International Conference on the Implications of AIDS for Mothers and Children was organized by the World Health Organization (WHO) in cooperation with the French Government. Co-sponsors included the United Nations organizations UNDP, UNICEF, and UNESCO, along with the International Labor Organization (ILO), the World Bank, and the Council of Europe. Following assorted introductory addresses, statements by chairmen of the conference's technical working groups are presented in the paper. Working group discussion topics include virology; immunology; epidemiology; clinical management; HIV and pregnancy; diagnoses; implications for health, education, community, and social welfare systems; and economic and demographic impact. Chairman statements include an introduction, discussion of the state of current knowledge, research priorities, implications for policies and programs, and recommendations. The Paris Declaration on Women, Children and Acquired Immunodeficiency Syndrome concluded the conference.
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1991 Apr; 98(4):345-8.Discusses dual concerns of the Royal College of Obstetricians and Gynaecologists (RCOG): that a widening gap between obstetric standards in Britain and those in the developing world exists and that the RCOG is unable to meet the needs of Third World doctors who come to the RCOG for postgraduate study. A meeting sponsored by Birthright and held at the Royal College of Obstetricians and Gynaecologists (RCOG) in June 1989 which explored aspects of Third World obstetric care reflects these concerns. The proceedings of the meeting have been published and verbatim recordings of the discussions are available on tape from the RCOG. Reports on maternal mortality/morbidity in the Third World indicate persistence of poor obstetrical practices and of common obstetrical complications. Suggestions for improvement include the redeployment of and the replanning of services within countries and an increase in health education for women. Access to care at the first referral institution level is seen as the key to the improvement of care. Problems of transport and communication create serious obstacles to the link between community care and the first referral institution. The goal of the World Health Organization (WHO) is to cut the Third World maternal mortality in half by the year 2000. To reach this goal WHO plans to field obstetric teams in Latin America, Africa and South Asia; to train nurse-midwives to perform life saving measures on their own initiative; and to employ community resources by training indigenous midwives to function as extensions of the health team. The RCOG will sponsor training designed for doctors who will work in developing countries.
[Unpublished] 1989. 6 p.Although there has been a lot of attention in researching maternal mortality world wide, there is little information on reproductive morbidity. A study in India in 1980 estimated that there were 16 cases of morbidity for every case of mortality. Assuming these estimates are accurate, the total number of cases of maternal morbidity would be 8,000,000 in the world every year. It is much harder to identify morbidity cases than as it is to identify mortality cases. To prevent and control reproductive morbidity, more must be known about its nature, type and incidence. There are indirect morbidities such as anemia, malnutrition, fatigue, and decreased resistance toward disease which can cause serious illnesses when pregnancy occurs. There are 3 types of reproductive morbidity, obstetric, gynecological, and psychological. The 1st is short term illness resulting from pregnancy and labor within 42 days of the end of pregnancy. This includes hemorrhage, sepsis, high blood pressure, ectopic pregnancy, and convulsions. The 2nd are more long term, such as reproductive infections, sexual diseases, fistulae and prolapse. The 3rd is caused by pressures on young girls by early marriage, early child bearing and repeated child bearing. In measuring morbidity bias in hospital or community studies must be considered. Hospitals will over-estimate acute diseases while underestimating other diseases and conditions. Interviews may be used but should be followed by clinical exams to identify specific infections. Various areas of a country and all age groups should be represented.
Lancet. 1989 Jun 10; 1(8650):1316-7.Vesicovaginal fistula (VVF), commonly caused by prolonged obstructed labor, is one of the worst complications of childbirth. Afflicted women continuously leak urine and sometimes feces, excoriating their mutilated vulvas and vaginas and often becoming social outcasts. Until the early part of this century, VVF was common in the United States and European countries, but today it is rarely encountered in developed countries. It is still, however, a major problem in many developing countries, where it is generally caused by neglect and mismanagement in labor. As many as 300 women suffering from VVF come to gynecology clinics for treatment every month in some areas of northern Nigeria. But many doctors do not wish to deal with VVF and their Western training does not equip them to perform needed surgery. The major thrust of research and development of services must be in prevention of VVF. But much can be learned about the disorder through treatment of its victims, and their suffering in and of itself demands a major treatment effort. This will require establishment of specialized centers, including hostel accommodations. International and national teams of medical experts would go periodically to needy areas to train local surgeons, advise on difficult cases, and help reduce patient backlogs. Such a program can only be set in motion through funds provided by international organizations. A WHO working group on VVF recently recommended urgent measures to prevent the disorder and to clear the backlog of patients waiting for operations. And an organization known as the VVF Initiative has been established in Nigeria and is in need of practical and financial assistance.
Lancet. 1989 Sep 30; 2(8666):795.In late August, the World Health Organization convened a technical working group in Geneva to consult on the measurement of reproductive morbidity in women. In many places ill health and injuries associated with childbearing are so common that people tend to accept them as normal and unavoidable, no matter how severe. Therefore the true extent of such illnesses is not known; according to some estimates, for every maternal death (of which there are some 500,000 a year) 10-15 women are injured or disabled by pregnancy or labor. The working group were seeking practical ways to measure reproductive morbidity. The need for community-based studies was recognized, and the working group thought that priority should be given to conditions such as vesicovaginal fistula, obstetric palsies, secondary infertility, sepsis, dyspareunia, prolapse and psychoses. One of the difficulties in measuring such morbidities will be getting access to the women and letting them know they can be helped. But the 1st step is to devise methods for measurement of reproductive morbidity. During the United Nations Decade for Women (1976-1985) the sheer suffering associated with maternity gradually became apparent. But much more than a decade is needed to recognize, measure, and correct the abuse and neglect of centuries. Could it be that we should be talking of WCH rather than just MCH? [full text]
Effective interception with the levonorgestrel-20-IUD contrarily to WHO advocated Lng-2-microdose IUD [letter]
CONTRACEPTION. 1988 Jun; 37(6):643.The World Health Organization's Special Program of Research, Development, and Research Training in Human Reproduction has investigated microdose administration of levonorgestrel to the uterine cavity and concluded that this approach is not safe or effective. In contrast to the excellent results obtained with 20 mcg of levonorgestrel release per 24 hours, the results of application of only 2 mcg release per 24 hours have been disappointing. There was a 6.7 increased relative risk of ectopic pregnancy with the levonorgestrel 2 IUD compared with the copper IUD, making this an unacceptable form of fertility control. On the other hand, the 12-month pregnancy rate for the levonorgestrel 20 IUD is 0.1/100 woman and the 12-month continuation rate is 80%. Removal rates for menstrual problems with this IUD are only 7.5%, and blood hemoglobin concentrations actually increase among users of the levonorgestrel 20 model.
WHO CHRONICLE. 1979 Sep; 33(9):322-5.The objectives of the 1978 World Health Organization (WHO) Expert Committee on Smoking Control were the following: 1) to review the most recent evidence on the harmful health effects of tobacco smoking; 2) to review the world situation with regard to smoking control; and 3) to provide strategy guidelines on legislation and restrictive measures, tax manipulations, and educational, information and other approaches which could assist governments' efforts to prevent the spread of the smoking habit in their respective countries. The report includes the following chapters: 1) the harmful health consequences of smoking; 2) socioeconomic implications of tobacco; 3) strategies for smoking control; 4) monitoring the national smoking problems and evaluating control activities; 5) legislation and restrictive measures to control smoking; and 6) helping the individual to stop smoking. Emphasis is on new evidence that has appeared since the publication of the 1975 report of the WHO Expert Committee on Smoking. The report stresses the harmful health effects of smoking on women, the risks of smoking during pregnancy, and the fact that smoking aggravates the risks to health that are present in many occupations. The committee pointed out that tobacco smoking also effects nearby non-smokers who are subjected to involuntary inhalation of somebody else's smoke. Along with the harmful health effects, there are also negative socioeconomic implications of tobacco production and use. Smoking-related diseases reduce the population's working capacity and thereby the gross national product. In developing countries tobacco production is seldom really profitable in the long term and can lead to important negative consequences for food production.