The importance of family planning in reducing maternal mortality

Maternal mortality in many developing countries remains at distressingly high levels despite improvements in hospital obstetrics. WHO estimates that 1/2 million maternal deaths occur each year, 99% of which are in developing countries. While many people expect that widespread acceptance of family planning will bring down levels of maternal mortality, some analyses have claimed disappointing reductions, though others were more encouraging. The primary reason for this discrepancy lies in the choice of measure of maternal mortality, compounded somewhat by a confusion in terminology. Maternal mortality can be measured by: 1) the number of maternal deaths; 2) the maternal mortality ratio; 3) the maternal mortality rate; or 4) the lifetime risk of death in childbirth. Family planning use influences the maternal mortality ratio only to the extent that it reduces the proportion of pregnancies to high-risk women. The maternal mortality rate can be substantially influenced by the prevalence of contraception, but it is primarily the reduction in the number of births, per se, that exerts the influence. The choice of measure should be determined by the issue being addressed, and which of the 2 determinants of maternal mortality (obstetric risk or prevalence of pregnancy) is the focus. Current levels of maternal mortality in the developed countries have been achieved only with both good obstetric care and with low fertility. In developing countries today, modern obstetric care is often available only in a few teaching hospitals, but family planning programs are feasible even in remote areas. While implementing family planning programs is not easy, it is more feasible than the implementation of significant improvements in the quality and availability of obstetric care. The contribution of family planning to lower maternal mortality and morbidity should not be underestimated.     

A strategy for reducing maternal mortality

A confidential system of enquiry into maternal mortality was introduced in Malaysia in 1991. The methods used and the findings obtained up to 1994 are reported below and an outline is given of the resulting recommendations and actions.     

孕产妇死亡的影响因素及降低孕产妇死亡率的对策

妇女儿童的健康与发展是一个国家和民族生生不息、兴旺发达的基础。随着人类社会的不断进步，国际上将妇女儿童的健康问题放到了重要的位置。妇女儿童作为特殊脆弱人群，保护他们的生存权和健康权是维护人类最基本权利的前提和基础，因此，孕产妇死亡率(以下简称MMR)和婴儿死亡率(以下简称IMR)不仅仅是反映卫生事业发展的重要指标，也是国际上衡量一个国家或地区国民健康素质及社会、经济发展和文明进步的重要指标。     

Assessing the wraparound process during family planning meetings

Research and evaluation of the wraparound process has typically focused on outcomes, service providers, and costs. While many of these studies describe a process that is consistent with the wraparound approach, few studies have reported attempts to monitor or measure the treatment fidelity of the wraparound process. The purpose of this study was to assess the fidelity of the wraparound process in a community-based system of care using the Wraparound Observation Form-Second Version. Results from 112 family planning meetings indicated some strengths and weaknesses within the current system. Families and professionals were frequently involved in the planning and implementation of the wraparound process. However, informal supports and natural family supports were not present in a majority of the meetings. Given the significant number of youth served in wraparound programs, the benefits of using the Wraparound Observation Form-Second Version as an instrument to monitor the fidelity of the wraparound approach should not be ignored.     

Success factors for reducing maternal and child mortality

Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula – fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women’s and children’s health towards 2015 and beyond.     

加强孕产期保健规范化管理降低孕产妇死亡率

哈尔滨市有7个行政区,12个县市。二、三级助产单位107家,乡镇级助产单位101家。2000年以来,孕产妇系统保健工作质量显著提高,孕产妇死亡率呈逐年下降趋势,2004年全市孕产妇总数为57312例,早孕建册率为65.8%,孕产妇系统管理率62.7%,住院分娩率92.0%,高危孕妇住院分娩率为100.0%。孕产妇死亡率为17.9/10万,较1999年下降了48.1%。现将我市加强孕产妇规范化管理,提高产科质量,降低孕产妇死亡率的具体做法总结如下。1加强乡镇卫生院产科建设,适时投入,为提高住院分娩率创造必要条件制定了“哈市乡镇卫生院产科设置标准、人员设备要求及职责范围”…     

The role of private providers in maternal and child health and family planning services in developing countries

This paper uses data from the Demographic and Health Surveys program (DHS) in 11 countries in Asia, Africa, and Latin America to explore the contribution of private health care providers to population coverage with a variety of maternal and child health and family planning services. The choice of countries and services assessed was mainly determined by the availability of data in the different surveys. Private providers contribute significantly to family planning services and treatment of children's infectious diseases in a number of the countries studied. This is as expected from the predictions of economic theory, since these goods are less subject to market failures. For the more 'public goods' type services, such as immunization and ante-natal care, their role is much more circumscribed. Two groups of countries were identified: those with a higher private provision role across many different types of services and those where private provision was limited to only one or two types of the services studied. The analysis identified the lack of consistent or systematic definitions of private providers across countries as well as the absence of data on many key services in most of the DHS surveys. Given the significance of private provision of public health goods in many countries, the authors propose much more systematic efforts to measure these variables in the future. This could be included in future DHS surveys without too much difficulty.     

提高计划生育服务质量与降低生育率

提高节育率,降低出生率,有效地控制人口增长速度,是我国计划生育工作的基本任务。提高技术服务水平是既往计划生育项目强调的重点。本文从不同的角度,介绍了将计划生育服务质量与生育率联系在一起的分析性框架,并通过框架分析和国内外一些研究成果,论证了提高计划生育服务质量与实现人口控制目标的一致性,即提高计划生育服务质量,以节育率的提高来降低生育率。     

通过促进计划生育和孕产妇健康消除贫困

“给计划生育注入新的活力”、“进一步发挥计划生育在实现千年发展目标中的作用”，这是2010年10月26～27日在印度尼西亚日惹举行的“通过促进计划生育和孕产妇健康消除贫困”国际会议上传出的呼声。人口与发展南南合作伙伴组织是世界人口领域唯一由发展中国家组成的政府间国际联盟，     

The role of the nurse in a family planning programme

The growth of a family planning clinic at Ilesha Western State Nigeria is described. Nurses were used to insert Lippes loops from an early stage. Insertions performed by supervised and unsupervised nurses are compared with doctor insertions.     

The decline in maternal mortality in Sweden: the role of community midwifery

The maternal mortality rate in Sweden in the early 20th century was one third that in the United States. This rate was recognized by American visitors as an achievement of Swedish maternity care, in which highly competent midwives attend home deliveries. The 19th century decline in maternal mortality was largely caused by improvements in obstetric care, but was also helped along by the national health strategy of giving midwives and doctors complementary roles in maternity care, as well as equal involvement in setting public health policy. The 20th century decline in maternal mortality, seen in all Western countries, was made possible by the emergence of modern medicine. However, the contribution of the mobilization of human resources should not be underestimated, nor should key developments in public health policy.