Evaluation of a community-based randomized controlled prenatal care trial in rural China

Background  

A community-based randomized control prenatal care trial was performed in a rural county of China during 2000-2003. The purpose of this paper is to describe the trial implementation and the impact of the trial on the utilization of prenatal care and perinatal outcomes.     

Illegal births and legal abortions – the case of China

Background  

China has a national policy regulating the number of children that a woman is allowed to have. The central concept at the individual level application is "illegal pregnancy". The purpose of this article is to describe and problematicize the concept of illegal pregnancy and its use in practice.     

Substance use and male gender as risk factors for deaths and suicide

OBJECTIVE: The aim of this study was to determine the mortality by suicide and other causes of death in a cohort of suicide attempters and identify predictive factors, including contact to healthcare after the attempt. METHOD: All consecutive 1198 deliberate self-harm patients treated in hospital emergency rooms in Helsinki during a 12-month period were identified. Data were gathered on healthcare contacts preceding and following the index attempt, and cause-specific mortality over a 5-year period. RESULTS: By the end of the 5-year follow-up period, 171 (14%) of the patients had died. A total of 57 (5%) had committed suicide. The age- and sex-adjusted risk for suicide among deliberate self-harm patients was 40-fold, and for death overall tenfold, compared to general population during the 5-year follow-up period. Risk factors for subsequent suicide were a diagnosis of substance use disorder, male gender and previous suicide attempts. A diagnosis of substance use disorder and male gender predicted death. Furthermore, male gender and substance use disorders had a strong interaction for both classes of death. CONCLUSIONS: The findings of this study suggest that deliberate self-harm patients have a high risk for both suicide and other causes of death. Male gender and substance use disorders are significant risk factors for both later suicide and other causes of death. Male suicide attempters with substance use disorders have remarkably high total and suicide mortality.     

Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study

Background  

The aim of this study was to comprehensively examine clinical risk factors, including suicide intent and hopelessness, for suicide and risk of death from all causes after attempted suicide over a 12-year follow-up period.     

Negotiating control and meaning: home birth as a self-constructed choice in Finland

Each society has its own consensual understanding of birth and its determinants: caregivers, location, participants and loci of decision-making, which in the Western world are based on biomedical knowledge. However, two competing cultural models of childbirth, the biomedical/technocratic model and natural/holistic model, mediate women's choices and preferences for the place and caregiver in childbirth. This article explores the way in which these cultural models of birth and the existing practical possibilities for choices shape women's and men's understanding of home birth. Based on interviews with 21 Finnish women and 12 Finnish men, the reasons for and experiences of planning and building toward a home birth are examined through an analysis of birth narratives. The analysis focuses especially on the women's definitions of what is 'natural' and their relationship with health services where biomedical practices and knowledge are the norm. The analysis shows that the notion of 'natural birth' holds various meanings in Finnish women's narratives namely self-determination, control, and trust in one's intuition. I seek to demonstrate that just as the biomedical management of childbirth exhibits distinct cross-cultural variation, so also does resistance to biomedical hegemony, as such resistance is strongly embedded in the local socio-cultural situation.     

Determinants of high sex ratio among newborns: a cohort study from rural Anhui province, China

This study analysed the relative contributions of three possible determinants to the high sex ratio among newborns in rural China - under-reporting of female births, abortions of female fetuses and excess early female neonatal mortality. A cohort of 3,697 pregnancies collected at village level in 20 rural townships from a county in Anhui province in 1999 was followed from pregnancy registration to seven days after birth. The cohort was later completed with 267 retroactively registered pregnancies. In the original cohort, the sex ratio at birth was 152 males to 100 females and in the supplemented cohort 159 males to 100 females, being similar to the sex ratios in the census data of the same townships. The risk of death for girls was almost three times that for boys during the first 24 hours of life. A comparison of the estimated number of missing girls by parity and pregnancy approval status to the recorded abortions and stillbirths suggests that selective abortions of female fetuses contributed most to the extremely high sex ratio among newborns. The under-reporting of female live births and neglect or poorer care of female newborn infants seemed to play a secondary role. New technology has helped the one-child policy to become, in practice, an "at-least-one-son" practice.     

Birth outcomes by level of obstetric care in Finland: a catchment area based analysis.

STUDY OBJECTIVE--To study whether hospitals of different levels are equally safe places to give birth in a regionalised system of care. DESIGN--This was a population based, cross sectional survey comparing birth outcomes in nationwide catchment areas of different levels of hospital care. All women and low risk women were examined separately. SETTING AND SUBJECTS--The study population comprised all women who gave birth in Finland in 1987-88. The data were obtained from the Finnish Medical Registry, complemented by official data. MAIN RESULTS--No statistically significant differences were found in crude or birthweight specific perinatal mortality rates between the catchment areas, nor did the other outcomes studied favour tertiary care compared with other levels of care in the area based analysis. CONCLUSIONS--In a regionalised system of birth care with a proper referral system, small local hospitals are as safe places to give birth as tertiary care hospitals.     

Maternal care in rural China: a case study from Anhui province

Background  

Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization.