RESUMO
We report cross-national regressions for maternal mortality in 49 developing countries, using indices of the adequacy of maternal health services derived from ratings by at least 10 experts per country. As in previous such regressions, a socioeconomic factor - in this case per capita income - has a significant effect, but having a trained attendant at delivery does not. Instead, the ratings index for access to services has a consistent, significant effect regardless of which estimates of maternal mortality ratios are predicted. Further analysis suggests that access to treatment for pregnancy complications and to services that help avoid pregnancy and birth are most closely related to lower mortality. Service ratings are interdependent, however, so that focusing only on individual services may not be productive.
Assuntos
Países em Desenvolvimento , Serviços de Saúde Materna/normas , Mortalidade Materna , Qualidade da Assistência à Saúde , Medicina Baseada em Evidências , Serviços de Planejamento Familiar/provisão & distribuição , Feminino , Acessibilidade aos Serviços de Saúde , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Renda , Gravidez , Análise de Regressão , Fatores SocioeconômicosRESUMO
OBJECTIVE: To assess maternal and neonatal health services in 49 developing countries. METHODS: The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country. The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training. FINDINGS: The average rating was only 56, but countries varied widely, especially in access to services in rural areas. Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding. Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling. CONCLUSION: Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions. Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion. Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion. Increased financing is only part of the solution.
Assuntos
Serviços de Saúde da Criança/normas , Países em Desenvolvimento , Serviços de Saúde Materna/normas , Indicadores de Qualidade em Assistência à Saúde , Benchmarking , Serviços de Saúde da Criança/estatística & dados numéricos , Serviços de Planejamento Familiar , Feminino , Política de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Recém-Nascido , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricosRESUMO
New estimates of trends in demographic indicators from the 1970s and revised projections for all countries and economies in the Region
Assuntos
Características da População , Desenvolvimento Econômico , Crescimento Demográfico/tendências , Previsões Demográficas/métodos , Previsões Demográficas , América Latina , Região do CaribeRESUMO
New procedures for projecting fertility for all countries incorporate past trends to generate short- and long-term population projects
Assuntos
Fertilidade/tendências , Previsões Demográficas , Crescimento Demográfico , Previsões DemográficasRESUMO
New procedures for projecting mortality in each country modestly change previous mortality projections
