An historical overview of the first two decades of striving towards Safe Motherhood

Maclean, Gaynor D.

doi:10.1016/j.srhc.2009.10.002

Cited by 15 publications

(12 citation statements)

References 18 publications

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“…By the 1990s the recognition that high risk mothers could not always be identified, and that every pregnancy faces risk was beginning to be understood [38,39]. The importance of antenatal care for all pregnant women, to improve both maternal and newborn health could not be disputed, but the importance of skilled professional care for all births, even for those not considered to be at risk was recognised [38].…”

Section: Antenatal Carementioning

confidence: 99%

“…Factors relating to access, economics, cultural beliefs, social support, knowledge of and attitude towards antenatal care, including women's personal experiences are all described [33][34][35][36][37][38][39]. A recent study conducted in Wosera, Eastern Sepik, identified that primary level education and marriage are significantly associated with attendance at antenatal clinic [40].…”

Section: Antenatal Carementioning

confidence: 99%

“…While the remoteness of many communities can make access to and uptake and availability of professional skilled health care during pregnancy and childbirth difficult [28,29,41], cultural and traditional beliefs and practices also impact on seeking and receiving care [29,39,41,42].…”

Section: Skilled Birth Attendantsmentioning

confidence: 99%

“…Other reasons for lack of skilled care during childbirth are similar to those for attending antenatal care: socio-economic and financial, lack of transportation and poor attitude of health staff towards women presenting for health care are all described [28,29,39,43].…”

Section: Skilled Birth Attendantsmentioning

confidence: 99%

“…But while women continue to give birth in the community they remain at risk [29]. Even with training, up skilling and deployment of trained health professionals skilled in midwifery and emergency obstetric care, women need access to health facilities, with staff working within an enabling environment [39, 45]. Southern 77% 73% 67% 65% 70% 80% 58% 57% 60% 58% 63% 67% Highlands 62% 50% 53% 54% 55% 57% 34% 28% 26% 30% 31% 33% Momase 68% 64% 62% 65% 63% 51% 34% 36% 31% 29% 31% 23%…”

mentioning

confidence: 99%

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Unsafe abortion and unsupervised births: understanding the challenges of pregnancy and childbirth in the rural highlands of Papua New Guinea

Vallely¹

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INTRODUCTIONPapua New Guinea (PNG) has one of the highest maternal mortality ratios in the world.Postpartum haemorrhage is the leading cause of maternal death, followed by sepsis related to childbirth and unsafe abortion, the same reasons as identified in other low-resource settings.PNG has a high rate of unsupervised births, with an estimated 60% of women giving birth unsupervised.Focussing on the leading causes of maternal mortality, the overall aim of this thesis is to describe women's perceptions and experiences of pregnancy and childbirth from one setting in the Eastern Highlands of PNG; and to describe a community-based intervention to improve maternal health outcomes. This thesis comprises of three studies, divided into two themes: (1) unsafe abortion; and (2) community perceptions and experiences of pregnancy and childbirth. METHODS Theme One: Unsafe abortionThrough a mixed methods approach, a six month prospective study was undertaken at the Eastern Highlands Provincial Hospital. Women admitted to hospital following both spontaneous and induced abortion were identified through the review of medical records.Clinical and socio-demographic data were captured using a study-specific case note record form. Semi structured and in-depth interviews were undertaken to provide further insight into women's experiences following induced abortion. Health care workers perceptions relating to abortion were also explored. Theme Two: Community experiences and perceptions of pregnancy and childbirthTwo studies were included in theme two. Both took place in the remote, rural area of Unggai Bena district, Eastern Highlands Province, an area with a high rate of unsupervised births.The first of these two studies used qualitative methods to identify knowledge, perceptions and experiences of pregnancy and childbirth. Focus group discussions, undertaken with men and women in the community, were followed by in depth interviews. During the in depth women's personal experiences relating to pregnancy and childbirth, especially their reasons for giving birth outside a formal health facility, were explored.iii The second study was designed following the findings from the first study. Through a community based intervention study, communities in the study site were provided with key messages relating to the importance of supervised, health facility births and recognising postpartum haemorrhage. Women attending antenatal clinic were invited to participate in a prospective study. After individual instruction 200 women were enrolled and provided with a clean birth kit which included 600mcg of misoprostol (a drug for reducing postpartum haemorrhage), for oral self-administration following an unsupervised birth. All women were followed-up postpartum when data relating to the acceptability of the intervention were collected using a study specific semi-structured questionnaire.All qualitative data were analysed through a content analysis approach using continuous comparison. All qualitative data were managed using NVivo v.9 (QSL Inter...

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Section: Antenatal Carementioning

confidence: 99%