Table of Contents
Chapters
- Fertility Continues to Decline
- Contraceptive Use
- Contraceptive Method Mix
- Awareness and Availability of Contraception
- Other Direct Influences on Fertility
- Fertility Preferences
- Young Women
- Child Survival and Health
- Maternal Health
Highlights
- Is fertility decline slowing?
- The impact of contraception
- Intentions to use family planning
- Injectables becoming popular
- Desired family size falling
- Premarital sex: New findings
- How AIDS affects child survival
- Maternal care falls short
Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA
Volume XXXI, Number 2,
Spring 2003
Series M, Number 17
Special Topics
Maternal Health
Skilled medical assistance during childbirth, whether at home or in a medical facility, can save women’s lives. Untreated or improperly treated complications of pregnancy, delivery, and the postpartum period are a leading cause of death for women in developing countries (77). To prevent maternal complications, skilled attendants are needed to provide assistance with delivery and monitoring of the postpartum period (66, 68, 108, 129, 139). Skilled attendants include doctors, nurses, and midwives trained to manage normal deliveries and who can also diagnose and refer or else manage obstetric complications.
Antenatal care can identify and treat conditions such as malnutrition, tuberculosis, syphilis, severe anemia, pre-eclampsia, and eclampsia. Skilled attendants can supply tetanus injections and iron and folate supplements and can advise women on health and nutrition during pregnancy. Also, they can help women make preparations for the birth and plan what to do if complications arise (68).
Maternal health practices often fall short, surveys show. One-fourth of women surveyed in developing countries received no antenatal care from a skilled attendant during their most recent pregnancy within the past five years. Over one-third did not obtain any tetanus toxoid injections, and nearly one-half had no skilled attendant at delivery. Only a few countries have made substantial improvements in these maternal health indicators since 1990.
 Patricia Poppe, JHU/CCP |
In Guatemala women await antenatal care at a rural clinic. Women in developing countries vary widely in access to skilled medical assistance during pregnancy and childbirth. |
Antenatal Care
Women in developing regions vary widely in access to antenatal care, based on 60 countries surveyed. In Asia and in the Near East and North Africa, nearly 60% of pregnant women received one or more visits from a skilled provider during their most recent pregnancies. In Bangladesh, Morocco, and Yemen, however, only one-third of women received such care, and in Pakistan just one-fourth. In contrast, in Indonesia and Jordan 9 women in every 10 received antenatal care from a skilled provider (see Table 14).
In sub-Saharan Africa an average of 77% of women saw a skilled attendant for antenatal care during their last pregnancy. In each of 30 surveyed countries except Chad, Ethiopia, and Niger, at least half of pregnant women received antenatal care, and in 11 of the countries, 90% or more. In Latin America and the Caribbean the average was 86%, with much lower rates in Bolivia (65%) and Guatemala (60%). In all surveyed countries of Eastern Europe and Central Asia, 90% or more of women received antenatal care from a skilled attendant during pregnancy, except in Azerbaijan and Kazakhstan.
Since 1990 the percentage of women who received skilled antenatal care increased slightly in Asia (6 percentage points), North Africa and the Near East (8 points), and Latin America and the Caribbean (7 points), but remained about the same in sub-Saharan Africa. Among 38 countries with repeated surveys, increases of 10 points or more in antenatal care coverage occurred in Bolivia, Haiti, Jordan, Mali, Nepal, Nicaragua, and Peru. In no developing country did the percentage of women receiving skilled antenatal care decrease by more than 3 percentage points (see Table 14).
Tetanus Toxoid Injections
Maternal tetanus killed an estimated 150,000 to 300,000 women during the 1990s (42). Tetanus spores infect women and children through unsafe or unclean deliveries, accounting for an estimated 5% of maternal deaths and 14% of neonatal deaths (119).
Tetanus toxoid vaccines can prevent infections and save the lives of mothers and infants alike. Pregnant women should receive at least two doses of tetanus toxoid, which provide one to three years of protection (122).
Among 56 countries with survey data since 1990, nearly two-thirds of women obtained one or more tetanus toxoid injections during a pregnancy within five years of being surveyed (see Table 14). Tetanus immunization and antenatal care are not always linked. For example, in Jordan nearly all women surveyed received antenatal care during their last pregnancy, but only about 40% received tetanus toxoid injections. Conversely, in Egypt about half of women received antenatal care, while nearly three-fourths received tetanus toxoid injections. Nearly 30% of women receiving a tetanus toxoid injection sought no other antenatal care (39).
On average, tetanus toxoid coverage is lowest in the Near East and North Africa, at 44%. In sub-Saharan Africa and in Asia, about three pregnant women of every five have had at least one tetanus toxoid injection, as have al-most four of every five in Latin America and the Caribbean.
The percentage of women who received a tetanus toxoid injection during pregnancy increased by an average of 5 percentage points among 36 countries with multiple surveys since 1990. Increases were greatest in Colombia and Peru. In four countries, however—Burkina Faso, Madagascar, Rwanda, and Uganda—tetanus toxoid immunization rates fell (see Table 14).
