Studies in family planning
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A community-based investigation of maternal deaths was undertaken in a rural province (Masvingo) and an urban area (Harare) of Zimbabwe in order to assess their preventability. Avoidable factors were identified in 90 percent of the 105 rural deaths and 85 percent of 61 urban deaths. Delay in seeking treatment contributed to 32 percent and 28 percent of rural and urban deaths, respectively. ⋯ Lack of appropriately trained personnel contributed to suboptimal care. In both settings, the severity of patients' conditions was frequently unrecognized, leading to delays in treatment and referral, and inadequate treatment. Appropriate community and health-service interventions to reduce maternal mortality are discussed.
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This report outlines a new technique for the estimation of maternal mortality by relating the sex differentials in mortality for people of reproductive age to the age schedule of fertility. The application of this method to the data from the Sample Registration System for 1982-86 indicates a level of maternal mortality of 580 deaths per 100,000 live births for India as a whole, 638 deaths in rural areas, and 389 deaths in urban areas. ⋯ The decline in the birth rate is estimated to have accounted for nearly one-fourth of the decrease in the maternal death rate and 5 percent of the fall in the maternal mortality ratio in the 10-year period between 1972-76 and 1982-86. The method of estimation described here is well-suited to the data circumstances in India.
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Since the 1960s, survey data have indicated that substantial proportions of women who have wanted to stop or delay childbearing have not practiced contraception. This discrepancy is referred to as the "unmet need" for contraception. The traditional interpretation, that these women lack access to contraceptive supplies and services, has led in turn to an emphasis on expanding family planning programs. ⋯ Although for many environments geographic access to services remains a problem, the principal reasons for nonuse are lack of knowledge, fear of side effects, and social and familial disapproval. This finding underscores the need for expanded investment in services that not only provide contraceptives, but also attend to closely related health and social needs of prospective clients. Programs are likely to be most successful when they reach beyond the conventional boundaries of service provision to influence and alter the cultural and familial factors that limit voluntary contraceptive use.
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A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. ⋯ Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.
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Maternal mortality and morbidity estimates in Nigeria continue to be dramatically high largely because maternal services, especially in rural areas, are often deficient and inappropriate to women's situations. The Safe Motherhood Project in Zone A examined the pregnancy-related knowledge, attitudes, and practices of community members, and women's use of community maternal health services. Focus-group discussions and interviews confirmed a number of recent findings by other studies; they also documented extensive hostility between the two most commonly used health-care providers: traditional birth attendants and midwives. The hostility resulted in rumors, deliberate attempts to discourage women from seeking higher levels of care, and refusals to accept referrals or treat patients, which were found to be serious constraints to good maternal care in the targeted rural area.