An intervention to improve maternal and child health was conducted in a remote Bolivian province with limited access to modern medical facilities. The intervention focused on initiating and strengthening women's organizations, developing women's skills in problem identification and prioritization, and training community members in safe birthing techniques. Its impact was evaluated by comparing perinatal mortality rates and obstetric behavior among 409 women before and after the intervention. Perinatal mortality decreased from 117 deaths per 1,000 births before the intervention to 43.8 deaths per 1,000 births after. There was a significant increase in the number of women participating in women's organizations following the intervention, as well as in the number of organizations. The proportion of women receiving prenatal care and initiating breast-feeding on the first day after birth was also significantly larger. The number of infants attended to immediately after delivery likewise increased, but the change was not statistically significant. This study demonstrates that community organization can improve maternal and child health in remote areas.

Objective: The purpose of this study was to determine the validity of maternal self reports of obstetrical complications, which are commonly used in estimating the prevalence of complications. These estimates vary greatly between countries and could either reflect true differences or reporting bias. Methods: A cross‐sectional study was conducted among 1027 women in two Bolivian maternity hospitals. A questionnaire recorded mothers' perceptions of obstetrical complications while hospital medical records and physical examinations established their clinical condition. Sensitivity, specificity, predictive values, and percent agreement were obtained for obstetrical conditions. Results: In general, women's reports of obstetrical complications did not match medical diagnoses. The highest agreement was obtained for reporting eclampsia, with less agreement for labor disorders, postpartum hemorrhage and malpresentation. Conclusions: Maternal self reports in this study did not provide a valid estimate of the prevalence of obstetrical complications. Health surveys based on maternal self reports must be interpreted with consideration of this limitation.

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Objective: The project aim was directed towards the goal to reduce maternal and newborn mortality through objectives to increase access to quality services; to promote client-oriented care and institute policy in support of improved maternal and newborn health. All project objectives were met during the duration of the project. Methodology..The results of increased quality and access were compared in seven MotherCare target districts to one control district. The MotherCare interventions included: provider training to clinical and client counseling skills; community-based information/communication (IEC) to increase women/families' awareness of pregnancy complications and appropriate actions to be taken, and policy promotions. The control area introduced only the IEC intervention. Data were collected from a similar facility monitoring system of key indicators and community-based surveys. The facility monitoring data were collected during the first six months of 1996,1997 and 1998. Results (Preliminary) 1.Facility deliveries in the MotherCare districts increased by 41%.