Rhm42755 1.3

placenta, was stopped when results showed that of misoprostol for prevention of post-partum misoprostol was found to have no clinically sig- nificant beneficial effect in women with retained An operational research project in North-West placenta. The study was carried out in Tanzania Nigeria was designed based on previous commu- between April 2008 and November 2011, with nity dialogues with local leaders that addressed patients who delivered at a gestational age of maternal health, post-partum haemorrhage warn- 28 weeks or more and had blood loss of 750ml ing signs, misoprostol and the importance of or less at 30 minutes after delivery. Interim analysis antenatal care and delivery in health facilities.
after recruitment of 95 patients showed that inci- Community members helped to define selection dence of manual removal of placenta, total blood criteria for community-based educators and birth loss and incidence of blood transfusions were simi- attendants, they identified trusted community lar in the misoprostol and placebo groups.1 members to serve as drug keepers and selectedthe moda, a common household vessel, as the 1. van Beekhuizen HJ, Tarimo B, Pembe AB, et al. A locally appropriate way to visualise excessive blood randomized controlled trial on the value of misoprostol loss. Drug keepers dispensed free misoprostol for the treatment of retained placenta in a low-resource tablets to traditional birth attendants, to pregnant setting. International Journal of Gynecology & Obstetrics women in their last month of pregnancy and to family members attending deliveries. A survey atthe end of the 12-month implementation periodshowed that 79% of the women who delivered at home took misoprostol after delivery.
This study assessed data on the association of child selected to work alongside existing trained female marriage with fertility, fertility control and mater- community health volunteers, in order to increase nal health care use outcomes in India, Bangladesh, acceptance of and willingness to use misoprostol.
Nepal and Pakistan among married, divorced The project achieved significant increases in cover- or widowed women, aged 20–24 years, from age, particularly among women delivering at Demographic and Health Surveys conducted in home, in part attributed to the fact that those 2005–2007. The proportion of ever-married women distributing misoprostol lived nearby. Intensive 20–24 years of age who reported having first community mobilisation from the design stage been married at age 17 or under ranged from of such interventions can lead to improved results 50% in Pakistan to 77% in Bangladesh. The pro- portion who reported marrying at 14 years orunder ranged from 12% in Nepal to 38% in 1. Ejembi CL, Norick P, Starrs A, et al. New global Bangladesh. More than two-thirds of the sample guidance supports community and lay health workers population lived in rural areas. Those without any in postpartum hemorrhage prevention. International formal education ranged from 15% (Bangladesh) Journal of Gynecology & Obstetrics 2013;122(3):187–89.
to 57% (Pakistan). Girls who married before age 18 were more than three times less likely to haveused contraception before first childbirth, to havehad a pregnancy termination and to have had an unintended pregnancy or pregnancies, compared with women who were married aged 18 or more.
A multi-centre randomised, placebo-controlled However, women first married before age 18 were trial, which sought to assess whether misoprostol not more likely to have given birth within the would reduce the need for manual removal of first year of marriage or to have closely spaced Round Up: Maternal health. Reproductive Health Matters 2013;21(42):1–3 births than women who married as adults. Overall, power relations between them influenced mater- the results suggest that child marriage is significantly nal health practices in 317 households in central associated with poor fertility outcomes and inade- Mali. Mothers-in-law had a strong influence on quate maternal health care use. However, there women’s reproductive health outcomes. Results was no significant association between early fertility were disaggregated for age, education, wealth and child marriage, possibly due to low fecundity and the pregnant woman’s position as a single at young ages, low coital frequency or both.1 wife, and first or subsequent wife in a polygamousunion. In cases where the mother-in-law sup- 1. Godha D, Hotchkiss DR, Gage AJ. Association between ported traditional practices, her preferences and child marriage and reproductive health outcomes and opinions affected the pregnant woman’s likelihood service utilization: a multi-country study from South of having received four or more antenatal care Asia. Journal of Adolescent Health 2013;52(5):552–58.
visits, having begun antenatal care in the first trimester, having delivered her last baby at ahealth facility and having received postnatal care.
The preferences and attitudes of the husband were not associated with receipt of health care.1 cost-effective, AustraliaThis randomised, controlled trial compared mater- 1. White D, Dynes M, Rubardt M, et al. The influence nal and neonatal outcomes for pregnant women of intrafamilial power on maternal health care receiving different types of midwifery care at two hospitals in Australia between 2008 and 2011.
mothers-in-law. International Perspectives on The study randomly assigned pregnant women to Sexual and Reproductive Health 2013;39(2):58–68.
one of two types of care: 871 pregnant women received all midwifery care, from antenatal throughto postnatal care, from one constant caseload mid-wife plus one back-up, and 877 pregnant women received standard care with rostered midwives in discrete wards or clinics. The proportion of cae- A survey among female sex workers in Swaziland sarean sections did not differ between the two found high levels of inconsistent or no condom groups of women. However, 8% of women in the use among those who were using non-barrier con- caseload group had elective caesarean sections, traceptive methods. Of 325 female sex workers compared to 11% of women receiving standard care.
who completed a survey in 2011, 16% were consis- More women in the caseload group underwent tent users of condoms alone, 39% used non-barrier labour without pain-relieving pharmaceuticals. Pro- modern methods without consistent condom use portions of assisted birth using forceps or ventouse, and 38% were inconsistent condom users or used unassisted vaginal births and epidural use were the other methods or none. Consistent use of condoms same, as were neonatal outcomes. Total cost of alone was more common among women who had care per woman was significantly lower (AUS$567 had no non-commercial partners in the past month less) with caseload midwifery. The study shows that than among those who reported two or more such for women of any risk, caseload midwifery is safe partners (39% compared to 3%). Respondents who and cost effective in a high-resource setting.1 had children were more likely than those who didnot to report use of non-barrier methods alone 1. Tracy SK, Hartz DL, Tracy MB, et al. Caseload (65% compared to 14%). The high levels of inconsis- midwifery care versus standard maternity care tent or no condom use among non-barrier contra- for women of any risk: M@NGO, a randomised ceptive users underscores the need to incorporate controlled trial. Lancet 2013;382(9906):1723–32.
HIV prevention into family planning interventions, particularly among female sex workers who havechildren and non-commercial partners.1 1. Yam EA, Mnisi Z, Mabuza X, et al. Use of dual protection among female sex workers in Swaziland.
This study examines how the attitudes of women, International Perspectives on Sexual and Reproductive their husbands and their mothers-in-law and the Round Up: Maternal health. Reproductive Health Matters 2013;21(42):1–3 35 stakeholders, focused on the impacts of mater- A review of vital registration data in 12 former nal death on surviving children. The majority Soviet states from 2005–2010 revealed elevated of caregivers in the sample were women. The sex ratios at birth in Armenia (117 males for gender inequalities that affect women’s health 100 females), Azerbaijan (116) and Georgia (121), across their lifespans and drive high levels of but not in other post-Soviet states. In the three maternal mortality also affect maternal orphans.
countries that have DHS data (Armenia, Azerbaijan Women’s lack of control over household financial and Moldova), sex ratios for first birth were high resources made it less likely that orphaned chil- for Armenia and Azerbaijan (138 and 113, respec- dren could fully access health and other services.
tively) and even higher in Armenia if the first child Social norms, that prescribe rigid gender roles was a girl (154). Overall, the number of girls born and de-emphasise fathers’ roles in child rearing, in Armenia and Azerbaijan in 2010 was 10% lower exacerbated the potential effect of a mother’s than expected. The authors highlight the need death on a child’s life, because fathers often to understand more about the social dynamics did not take responsibility for guardianship of their own children after a maternal death. Thesenorms also contribute to family dissolution − 1. Michael M, King L, Guo L, et al. The mystery of orphans are commonly spread out among other missing female children in the Caucasus: an analysis women in the extended family. The costs of failing of sex ratios by birth order. International to address preventable maternal mortality include Perspectives on Sexual and Reproductive Health impacts on the nutritional status, health, and edu- cation of living children, as well as the economiccapacity of families.1 1. Yamin AE, Boulanger VM, Falb KL, et al. Costs of inaction on maternal mortality: qualitative evidence This qualitative study, conducted in 2012–13 in of the impacts of maternal deaths on living rural Tanzania with 45 family members of women children in Tanzania. PLoS ONE 2013;8(8):e71674.
who had died from maternal causes and with

Source: http://www.rhmjournal.org.uk/publications/journal-roundups/December-2013-maternal-health.pdf