Studies in family planning
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Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.
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Of all the reforms and policies set in motion in the early 1980s in China, the one-child policy has been called the most far-reaching in its implications for China's population and economic development. Almost two decades later, little is known about what the policy looks like across local neighborhoods and villages. ⋯ Local policy, including policy strength and policy incentives and disincentives, is detailed separately for urban and rural areas. These data confirm that no single one-child policy exists; policy varied considerably from place to place and within individual communities during the 1989-93 period.
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Comparative Study
The validity of verbal autopsies for assessing the causes of institutional maternal death.
This report presents data from a study carried out in three African countries to assess the validity of verbal autopsies--based on information about symptoms and signs observed antemortem by relatives or associates of deceased individuals--for determining the causes of institutional maternal death. The validity of the verbal autopsy was assessed for each cause of death; and for groups of "direct" and "indirect" maternal causes, by comparing the verbal autopsy diagnoses with the reference diagnoses and calculating their sensitivity, specificity, and positive predictive value. ⋯ Verbal autopsy estimates of cause-specific mortality were comparable to expected values for most of the causes. The study shows that certain direct causes of hospital-based maternal mortality can be determined by means of verbal autopsies with a reasonable level of confidence.