To select the proper interventions that could prevent maternal mortality, adequate and appropriate maternal mortality data are needed. Nevertheless, the quality and quantity of information and the scope of maternal health- and death-related data are inadequate in many countries, particularly in the developing world. From January 1993 to December 1996 a surveillance program in maternal mortality was developed to conduct surveillance studies in the department of Guatemala, Guatemala. With an active surveillance system, our approach gave a more complete picture of maternal death and produced information on the specific causes of maternal mortality. Using multiple sources of information, we reviewed and analyzed all deaths of women of childbearing age (10 to 49 years). Each death was investigated to determine whether it was pregnancy-related or not. The maternal mortality ratio for the four-year study period was 156.2 deaths per 100,000 live births. Women 35 and older had a higher risk of maternal death than women under that age. Women who were 35-39 years old had a maternal death risk almost three times as high as women aged 20-24. For women who were 40 or older the risk was more than double that of women 20-24 years old. Overall, the two leading causes of maternal mortality were infection and hemorrhage. Vaginal deliveries where there was medical assistance had the highest rate of delivery-related maternal death from general infection. In deliveries attended by nonmedical personnel, delivery-related maternal deaths from hemorrhage were most frequently associated with retained placenta. Developing countries are called on to implement systems that can provide continuous and systematic data collection so that policymakers and health managers have adequate information to design proper interventions to save women's lives.

The general purpose of this project was to increase the awareness of and access to emergency contraception (EC) among the medical community in Guatemala. Specific project objectives included: 1) training three physicians as trainers in all aspects of EC; 2) adapting and disseminating scientific literature and informational materials about the method and about EC programs in Latin America and worldwide; and 3) training at least 250 participants about the characteristics of emergency contraception, its mechanisms of action, and counseling techniques. On October 2002, a group of five health workers attended the Latin American Conference on Emergency Contraception organized by the Latin American Consortium on Emergency Contraception (LACEC) and the Population Council's Frontiers in Reproductive Health Program (FRONTIERS) in Quito, Ecuador. Conference participants were trained to implement and follow-up emergency contraception activities in their country. Upon their return to Guatemala and under the leadership of the Center for Research in the Epidemiology of Sexual and Reproductive Health (Centro de Investigación Epidemiológica en Salud Sexual y Reproductiva-CIESAR), the five conference participants established the Guatemalan Consortium on Emergency Contraception (GCEC) to coordinate information and training activities on emergency contraception in the country. The five founding members of GCEC acted as project coordinators. They developed and adapted training, educational, and informational materials to be used and distributed during workshops. They trained 10 trainers to replicate the EC workshop among interested organizations and professional groups. Between February and April 2003, these trainers conducted a total of 21 workshops that were attended by 556 participants. Workshops were held among medical and nursing organizations, nongovernmental organizations (NGOs), selected hospitals, and members of Guatemala's justice system. In total, 124 doctors, 121 nurses and social workers, 54 health workers, 144 members of the justice system, 46 female community leaders, and 67 health promoters were trained during this period. The workshops increased the participants' knowledge of EC. The proportion of trainees with high levels of knowledge (75 or higher on a 100-point scale) increased from 11 percent to 40 percent.

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