Caesarean section in countries of the Eastern Mediterranean Region

This paper reviews global data on caesarean section [CS] focusing on Eastern Mediterranean Region [EMR] countries for which data could be obtained. CS rates in the EMR tend to average around 10%. The data, however, are often not representative of the whole country, being mostly hospital rather than community based. Global and regional CS trends, determinants, and outcomes are presented. Controversies and consensus over the indications for CS are reviewed. The cost of rising CS rates, women's involvement in decision-making, the role of health workers, data quality and legal aspects are highlighted, with discussion of the aim of reducing unduly high CS rates and promoting high-quality maternity care

antenatal care debate

The antenatal care debate has focused on the frequency of antenatal care, its content, continuity, quality, organization, effectiveness and impact on morbidity and mortality. Established antenatal care schedules have been called into question. Randomized controlled trials comparing reduced schedules with routine antenatal care have shown similar or better outcomes for the reduced protocols. Furthermore, midwives, with or without physicians, can provide continuous maternity care comparable to obstetrician-led care. Some women disliked the new protocol, but a reduced protocol of high quality provided by competent midwives is cost-effective, spares scarce physicians and ensures women's satisfaction. It is recommended globally

Integrating maternal and child health with primary health care in Saudi Arabia

Integration is an important tool for successful implementation of components of a comprehensive health programme. We describe strategies adopted to integrate the Saudi maternal and child health [MCH] activities with other primary health care [PHC] components in order to achieve optimal quality care. Achieving such integration was one of the specific objectives of the MCH programme. Besides training MCH workers, other important tools of MCH/PHC integration included: organization, supervision, continuing education, data management and health systems research. The strengths and weaknesses of integration are discussed while the opportunities, limitations and implications are reviewed

Reflections on maternal mortality in two decades

The paper examines developments in the assessment and prevention of maternal mortality over the past 2 decades through review of the relevant literature. Problems of classifying and ranking causes, changing methodologies, discrepancies and illogical trends are demonstrated. Identifying causes of maternal mortality by surveillance and death reviews, rather than measuring ratios, appears to be more effective. Process indicators are considered as important as outcome indicators for monitoring safe motherhood. International technical reappraisal of maternal mortality is needed