Socioeconomic barriers to safe motherhood among booked patients in rural Nigerian communities.

This study examines the socioeconomic barriers to safe motherhood in booked patients in the Ife-Ijesha health administrative zone, Nigeria. During the period of study (January 1998 to December 1998), 161 booked patients of Ife State Hospital, Ile-Ife and Wesley Guild Hospital, Ilesha presented with an avoidable obstetric emergency, Seventeen (10.6%) presented during the antenatal period, while 89 (55.3%) and 55 (34.2%) presented in labour and postpartum respectively. The patients presented with obstetric complications such as obstructed labour (24.2%), postpartum haemorrhage (21.1%), puerperal sepsis (24.2%), imminent eclampsia and eclampsia (15.5%), retained second twin (9.3%). Three maternal deaths occurred (MMR 1467/100 000 births) and the perinatal mortality rate was 290/1000 total births. The adduced reasons for late presentation included, financial constrains (85.1%), poor access to hospital/transportation difficulties (33.5%), objection to hospital admission by relatives (23.0%), aversion to caesarean section (21.7%) and attitude to hospital staff (8.1%). The patients were of the opinion that reducing the economic burden associated with hospital fee, provision of transportation, encouraged family support and reduction of operation rate would lead to reduction in late presentation.     

围产保健与母亲安全

母亲安全 ,儿童优先是围产医学永恒的主题。该主题的初期目标是降低孕产妇和围产儿死亡率 ,中期目标是降低母婴发病率和残疾率 ,终期目标是提高人口素质。保障母亲安全是社会的责任 ,是妇女基本人权的体现。妊娠分娩是女性生殖健康的重要一环 ,关系到母子生命安全 ,是女性生殖健康中惟一涉及到一个以上个体的阶段。妊娠分娩虽然是正常的生理过程 ,但每个母亲和婴儿的健康与生命在这个过程中都面临着危险 ,母亲安全就是帮助母亲 ,克服和战胜这些危险 ,安全幸福地将一个新生命带到我们这个世界。“妊娠人生大事 ,务使母婴平安”是 1998年为纪…     

Human rights to safe motherhood.

Each year an estimated 515000 women die of complications of pregnancy and childbirth, 7 million more suffer serious health problems and 50 million suffer adverse health effects. Over 98% of deaths occur in resource-poor countries. However, poverty alone neither justifies nor necessarily explains death rates. The Inter-Agency Group for Safe Motherhood, composed of six leading international agencies, has identified major medical causes of unsafe motherhood, and their origins in medical and health system failures, and in the failures of social justice that underlie them. These include women's 'inadequate education, low social status, and lack of income and employment opportunities.' This paper addresses the role of human rights to redress inequities that condition unsafe motherhood, and identifies five critical rights the observance of which would facilitate safe motherhood. These are women's rights to life, to liberty and security of the person, and to health, maternity protection and non-discrimination.     

Human rights aspects of safe motherhood

Maternal deaths in developing countries are often the ultimate tragic outcome of the cumulative denial of women's human rights. Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving. Maternity is a social function and not a disease. When women are risking death to give life, they are entitled to have their own right to life and health protected. Societal attitudes of looking at women as means and not ends have resulted in the denial of women's rights to essential maternity services. A signal of hope is that safe motherhood is now on the world agenda as one of eight Millennium Development Goals. The global community of obstetricians has a major responsibility to help make motherhood safer for all women.     

A safe motherhood education and counselling programme in Istanbul

Objective?Evaluation of an education/counselling programme intended for pregnant/puerperal women in a secondary health care facility.

Methods?The education/counselling programme was launched in September 2004, following the preparation of environmental and material components. Evaluation of the two-year project was achieved by means of satisfaction surveys of service receivers and service providers, an information survey of service receivers and focus group discussions (FGDs) for both groups.

Results?Forty percent of the pregnant women who attended antenatal visits and 90% of those who had recently delivered were given education/counselling in accordance with the project. The information survey showed that 92.5% of the pregnant women knew that they should take an iron supplement during pregnancy and the puerperium; 72% of the puerperal women knew of the danger signs postpartum and concerning the newborn, and 70% were aware of the methods of effective breastfeeding. The FGDs showed improved competence of the applicants in pre-delivery, pregnancy and puerperal care as well as in newborn nutrition. Feedback from service providers confirmed the patients' improved active participation in their self-care.

Conclusion?The safe motherhood education/counselling programme was successfully completed. The applicants and health care professionals benefited from the service.     

Rights to safe motherhood and newborn health: Ethical issues

Worldwide, one woman dies every minute as a result of being pregnant. This statistic highlights the denial of women's rights to safe motherhood in many parts of the world, particularly in low-resource countries where 98% all maternal deaths occur. The majority of pregnant women die because they deliver unattended by a properly trained birth professional. According to the 1948 Universal Declaration of Human Rights, every woman has the right to a standard of living adequate for the health and well-being of herself and her family, including medical care. The principle of moral philosophy supporting women's rights to safe motherhood may be difficult to implement. Philanthropy is diverted by other competing needs, such as HIV prevention and treatment, or provision of urgent food supplies. Equity is denied because women's health is too often set as a low priority. Utilitarianism advocates that safe motherhood is an investment of societal shared interest.     

Poor and pregnant in Africa: safe motherhood and human rights

Currently almost 600,000 women die in the world each year owing to the effects of childbirth. The greater proportion of these deaths occur in developing countries. This issue is considered in the light of human rights and equity. This paper was presented in a Plenary session at the Perinatal Society of Australia and New Zealand's third annual congress in Melbourne, March 1999.     

Reproductive and sexual health and safe motherhood in the developing world.

The aim of this paper is to discuss the main hurdles and possible solutions concerning reproductive and sexual health and safe motherhood in the developing countries. In response to the changing global situation, a broader new concept of reproductive health has emerged. The Programme of Action of The International Conference on Population and Development (ICPD) emphasizes and highlights various aspects of reproductive health. No population in the world has met the goals of the ICPD. The problems are particularly acute in developing countries: between 20 and 40% of births are unwanted or wrongly timed, posing hardships for families and jeopardizing the health of a million women and children. An estimated 50 million induced abortions are performed each year, with some 20 million of these performed under unsafe conditions or by untrained providers. Almost 600,000 women die every year due to pregnancy-related causes, 99% of them in developing countries. Approximately 7.6 million infant deaths occur during the perinatal period each year. There are more than 333 million new cases of curable sexually transmitted diseases world-wide each year. Nearly 22 million people are estimated to be infected with the human immunodeficiency virus, of whom 14 million are in sub-Saharan Africa, with rapidly increasing numbers of infected persons in South and South-East Asia. When compared to the developed world, these figures are staggering because of barriers operating at different levels and preventing women from receiving care that is timely and of good quality. United efforts of obstetricians, pediatricians, sociologists, and different governmental and non-governmental organizations are required to achieve our targets.     

The state of political priority for safe motherhood in India

Approximately one-quarter of all maternal deaths occur in India, far more than in any other nation on earth. Until 2005, maternal mortality reduction was not a priority in the country. In that year, the cause emerged on the national political agenda in a meaningful way for the first time. An unpredictable confluence of events concerning problem definition, policy alternative generation and politics led to this outcome. By 2005, evidence had accumulated that maternal mortality in India was stagnating and that existing initiatives were not addressing the problem effectively. Also in that year, national government officials and donors came to a consensus on a strategy to address the problem. In addition, a new government with social equity aims came to power in 2004, and in 2005, it began a national initiative to expand healthcare access to the poor in rural areas. The convergence of these developments pushed the issue on to the national agenda. This paper draws on public policy theory to analyse the Indian experience and to develop guidance for safe motherhood policy communities in other high maternal mortality countries seeking to make this cause a political priority.     

The state of political priority for safe motherhood in Nigeria

Achieving the ambitious maternal mortality reduction aims of the Millennium Development Goals will require more than generating sufficient donor support and carrying out appropriate medical interventions. It also will necessitate convincing governments in developing countries to give the cause political priority. The generation of political priority, however, is a subject that has received minimal research attention. In this article, we assess the state of political priority for maternal mortality reduction in Nigeria, which has more maternal deaths in childbirth than any country except India. We also identify challenges that advocates face in promoting priority. We find that after decades of neglect, a policy window has opened for safe motherhood in Nigeria, giving hope for future maternal mortality reduction. However, priority is as yet in its infancy, as advocates have yet to coalesce into a potent political force pushing the government to action. The case of Nigeria suggests that there is an urgent need for safe motherhood policy communities in countries with high maternal mortality to transform their moral and technical authority into political power, pushing policy-makers to action. We offer a number of suggestions on how they may do so.