Reducing maternal mortality in the developing world: sector-wide approaches may be the key

Avaliação preliminar do programa de humanização no pré-natal e nascimento no Brasil

“…Embora parcela significativa tenha calendário e conteúdo similar, seu desenvolvimento apresenta muitas diferenças: em relação aos profissionais envolvidos, às práticas recomendadas e às práticas efetivadas, além das diferentes taxas de adesão de mulheres 14,15 . Apesar de o pré-natal ser considerado um dos quatro pilares da maternidade segura, poucas avaliações sistemáticas haviam sido realizadas sobre a efetividade destes programas, a fim de determinar quais intervenções teriam melhores resultados [14][15][16][17][18] . Mais recentemente, vários autores têm discutido a importância da assistência pré-natal, seus critérios, as bases científicas das intervenções que são realizadas e as repercussões sobre a saúde materna e perinatal 19 .…”

Between Intent and Achievement in Sector-Wide Approaches: Staking a Claim for Reproductive Health

“…While the integrated concept of reproductive health may have broad currency, the donors and agencies supporting the diverse elements of reproductive heath have limited interest in changing the resource inequities evident between them. Goodburn and Campbell [22], in advocating SWAps as a potential key to the reduction of maternal mortality, highlight this anomaly. The studies they quote suggest that almost half of development assistance in health is directed towards the broad category of reproductive health.…”

“…[22] While improved maternal outcomes are a desirable consequence of health system reforms, this passive acceptance of vertical solutions for specific services makes the achievement of comprehensive reproductive health care much less likely. The inequity that was previously apparent in the me elange of uncoordinated projects [17] will continue, if donor agencies, while acknowledging the importance of a comprehensive reproductive health paradigm, seek to protect their own particular project interests.…”

“…The predictability of outcomes, however, is dependent on a range of variables, and is not consistent across all aspects of reproductive health. Goodburn and Campbell [22] argue strongly for the potential reduction in maternal mortality accruing from reforms that establish functioning district health systems, extend coverage and improve the overall quality of health services, citing progress in China, Sri Lanka and Malaysia. Their caveat on integration in reproductive health programmes is the potential loss of that strength of focus needed to secure improvements in maternity care.…”

“…In terms of reproductive health, the need for strong advocates at the policy table will be critical to outcomes, but Goodburn and Campbell [22] have been unable to identify any donor -supported SWAp that has emphasized safe motherhood as an indicator condition or goal, with maternal mortality overlooked as an issue even where maternal health problems are significant. Reproductive health advocates need to target the major donors, placing the complex needs of reproductive health back on the international agenda, arguing for greater support for its component programmes, and promoting models for integration of reproductive health services into health sector reform processes.…”