Recent estimates of global maternal mortality indicate that for the first time since the Safe Motherhood Initiative of 1987, deaths due to pregnancy-related causes are on the decline. Defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, maternal mortality is one of the strongest health statistics showing the disparity between poor and rich countries. Although a global decline is documented, challenges to reducing maternal mortality, and meeting Millennium Development Goals (MDGs) for maternal health remain, particularly in many Sub-Saharan African and Southeast Asian countries. This study presents an assessment of Cambodia’s progress towards reaching the Millennium Development Goal of reducing maternal deaths by ¾ by 2015. The report examines issues related to the improvement of maternal health, outlining the magnitude, determinants, and prevention methods of maternal mortality globally and in Cambodia. Cambodia’s health policies and contextual factors impacting the maternal mortality ratio such as dramatic increases of skilled health personnel for delivery, delivery in health facility, and use of antenatal care are identified as key contributors to MMR reduction. Continued progress in reducing maternal mortality in Cambodia requires improvements to midwifery skill, competencies around normal and emergency birthing care, and salaries of midwives as well as an incentive for new graduates to work in the public sector. An increase in the cooperation between government health centers and hospitals are crucial to ensure obstetric referrals, supervision of health center staff, and an improvement in maternal death data collection. Finally a national priority to increase the use of family planning and safe abortion will significantly contribute to the continued reduction of MMR.

This study examines global incentives to reduce maternal mortality, namely the fifth Millenium Developmnet Goal to reduce maternal mortality with 75% by 2015. More specifically it examines maternal mortality and obstetric care in situations of emergency. When exposed to extreme situations the risks of negative pregnancy- and delivey outcomes are increased. Data was collected from seconday sources and from interviews with health staff with experiences from humanitarian work in the field. The findings were analyzed using a theoretical framework explaining maternal mortality be referring to both direct and indirect causes. The two theoretical models used in the study are similar and reminds of each other when explaining maternal mortality. One is based on the assumption that an obstetric complication has occurred and differnt delays in recieving care is the main cause maternal mortality, whilst the other theory is more in depth and elaborates the underlying causes. The first theory is used a base tto analyze the data after which the other theory is applied in order to introdue a deeper dimension to the analysis. The findings suggest that direct causes accounts for 80 per cent of all maternal deaths, homorrhage being the largest, including in disasters. Further causes are infections, unsafe abortions, eclampsia and obstructed labor. Also, underlying socail factors such as gender inequality indirectly has a negative impact on maternal mortality. Moreover, findings suggest that obstetric care is prioritized in disaster relief response.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (M.P.H.)--University of Michigan, 1946.

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Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-11-30T12:48:11Z No. of bitstreams: 2 Dissertação - Juliete Teresinha Silva - 2017.pdf: 2775678 bytes, checksum: d9432664d8d88f044032b78414a5c6e5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-11-30T12:50:10Z (GMT) No. of bitstreams: 2 Dissertação - Juliete Teresinha Silva - 2017.pdf: 2775678 bytes, checksum: d9432664d8d88f044032b78414a5c6e5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-11-30T12:50:10Z (GMT). No. of bitstreams: 2 Dissertação - Juliete Teresinha Silva - 2017.pdf: 2775678 bytes, checksum: d9432664d8d88f044032b78414a5c6e5 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-08-29 / Maternal mortality is still a problem of public health in all the world, mainly when we take a look at the developing countries. The reason for maternal mortality (RMM) enables the visualization of the place that women occupy in a society and how the health system takes care of their specific need based on the principle of equity. During the pre-natal a careful attention can identity pregnant women that have a bigger risk making it possible that we make a planned approach that will avoid occurrences of emergency situations that are always accompanied by bigger chances of maternal and neonatal morbimortality. Evaluate the perception of the professionals in the health field, their practice in the care of pregnancy in the primary assistance for the elaboration of a proposal of a permanent education program in health, as a strategy to reduce the maternal mortality in the county of Jataí in the state of Goiás. It was done a descriptive, exploratory, transversal study, of a qualitative approach in the health education. The secondary data referring maternal mortality in Brazil in these five years (2011 to 2015) were extracted from information of the ministry of health (SIM – System of Information of Mortality). The collecting of data referring the perception of professionals about permanent health education was obtained through a focal group. The analysis of the data was done through content analysis. The RMM in the county of Jataí in the year of 2015 was 142 deaths/100,000 born alive, similar to the year of 1990 when it was established as a goal of the 5th ODM that this indicator reached the level of 35 deaths / 100,000 born alive in 2015. The pre natal is done by a multiprofessional team that knows their role in the care of pregnancy in APS, however fragile points were pointed concerning the quality of this assistance, the team work and the knowledge and practice of EPS. The professionals involved in the research do not know the PNEPS, and there is not a practice of EPS in the work place considering that the knowledge of the health education limits itself to the education destined to SUS users. Acting at APS by the practice of a permanent education in health is the proposal strategy to contribute for the changing of the scenary of maternal mortality in the place of the studies. / A mortalidade materna continua sendo um problema de saúde pública no mundo todo, principalmente quando lançamos o olhar sobre os países em desenvolvimento. A razão da mortalidade materna (RMM) possibilita a visualização do lugar que a mulher ocupa na sociedade e como o sistema de saúde cuida de suas necessidades específicas, com base no princípio da equidade. Durante o pré-natal uma atenção cuidadosa pode identificar gestantes de maior risco permitindo que se faça uma abordagem planejada que evitará ocorrências de situações emergenciais, que são sempre acompanhadas de maiores chances de morbimortalidade materna e neonatal. Este estudo procurou compreender a percepção dos profissionais da área de saúde sobre suas práticas no cuidado à gravidez na Assistência Primária, para a elaboração de uma proposta de um programa de Educação Permanente em Saúde, como estratégia para redução da mortalidade materna no município de Jataí, no estado de Goiás. Trata-se de uma pesquisa qualitativa exploratória, sendo que a coleta de dados referentes à percepção dos profissionais sobre Educação Permanente em Saúde, assistência pré-natal e mortalidade materna foram obtidos através da técnica do grupo focal.A análise dos dados obtidos foi realizada por meio da Análise de conteúdo Temática, proposta por Bardin e revisitada por Minayo.Os dados secundários referentes à mortalidade materna no Brasil e em Jataí entre os anos de 2011 a 2015 foram extraídos de informações do Sistema de Informação de mortalidade do Ministério de Saúde (SIM). A RMM no município de Jataí no ano de 2015 foi de 142 mortes/100.000 nascidos vivos, igual ao ano de 1990 quando foi estabelecido como meta do 5º ODMque este indicador alcançasse o patamar de 35 mortes/100.000 nascidos vivos em 2015. O pré-natal é realizado por uma equipe multiprofissional, não sendo caracterizado um trabalho em equipe interprofissional. Foram identificados pontos frágeis quanto à qualidade da assistência pré-natal, ao trabalho em equipe e aos saberes e prática de EPS. Os profissionais envolvidos na pesquisa desconhecem a PNEPS, não havendo no local do trabalho a prática da EPS, sendo que o conhecimento de educação em saúde se limita à educação destinada ao usuário do SUS. Atuar na APS por meio da prática de uma Educação Permanente em Saúde é a estratégia proposta para contribuir na mudança do cenário da mortalidade de mães no local do estudo.

Magister Public Health - MPH / Background: Maternal mortality is a significant public health problem world-wide,as it is an important indicator for the functioning of the health system. The maternal mortality ratio for Botswana is higher than other countries with comparable economic growth, despite impressive access to health services. In order to develop relevant programs and policies to reduce maternal mortality, the factors associated with maternal mortality were studied. The study aimed to describe the maternal and health services factors associated with maternal mortality in South East Botswana. Methodology: A quantitative case-control study was used to retrospectively review medical records for 71 cases of maternal deaths and 284 controls randomly selected from mothers who delivered in the same year and at the same health facility, in South East Botswana from 2007 to 2009. Information was collected on the maternal and health services characteristics of the cases and controls including age, level of education, marital status, parity, utilization of health facilities that consist of antenatal care (ANC), type of delivery, complications during pregnancy, type of health facility and ANC provider. Data was analyzed using Predictive Analysis Software (PASW) Version 18.Two-sample t- test, Pearson’s Chi-square test and the Fisher’s exact test were used to test the difference between the proportions of the various categories of variables in cases and controls. Univariate logistic regression analysis was applied to identify the risk factors associated with maternal deaths. A multivariate logistic regression model was estimated to see the joint effects of the identified risk factors for maternal mortality. Hosmer and Lemeshow test was used to test the goodness of fit of the model. Results: The mean age of the maternal deaths was 28.0 ± 5.3 years and they had taken place at a hospital (100%). A large number of deaths occurred before delivery(59.0%). The causes of maternal death included both direct (73%) and indirect causes (27%). Direct causes were the leading causes of death and they were abortion(22.5%) and haemorrhage (18.3%). The maternal characteristics associated with maternal mortality were having complications at delivery (OR=20.91), not receiving ANC (OR=6.31) and delivering by caesarean section (OR= 2.66). The health facility characteristics associated with maternal mortality were delivering outside the health facility (OR=14.78), having been referred from another facility (OR=8.62) and delivering at a general hospital (OR=5.91). The data produced a model with good fit that included one maternal risk factor and three health facility risk factors. These were being admitted with preterm labour, delivering at a general hospital or before arrival at the health facility and having been referred from another health facility. Conclusion: Maternal mortality was associated with both maternal and health facility risk factors. The model developed may be used to identify and manage highrisk women to reduce the number of maternal deaths. It was recommended that, the current system should continue to be monitored and evaluated through the Maternal Mortality Monitoring System (MMMS). Furthermore, the referral and management of complications needs to be strengthened through a multi-sectoral approach.

Black expectant mothers are more likely to die from pregnancy-related complications than white expectant mothers. While researchers have long documented this disparity, the gap persists. The purpose of this literature review is to describe the white-black disparity in maternal mortality and morbidity, identify racism and discrimination across multiple ecological systems as a primary driver of this disparity, and suggest implications of this for social work practice. This review presents basic statistics and means of data collection regarding this disparity, acknowledges known risk factors for pregnancy-related deaths, and identifies the association between racism and discrimination in healthcare settings and this white-black disparity. A bioecological framework will be used to further analyze the implications of racism on multiple ecological systems. The conclusion presents existing interventions and provides recommendations for social workers regarding this healthcare disparity.

<p>Indonesia consistently records higher levels of maternal mortality than other countries in Southeast Asia with its same level of socioeconomic development. I use a quasi-experimental, difference-in-differences approach to understand whether the role of information on the risk of death in childbirth can change women’s reproductive behaviors. In the first two chapters, I use the Maternal Mortality Module from the Demographic and Health Survey (DHS) in Indonesia to examine fertility and reproductive behavior responses to a sister’s death in childbirth. Fertility desires remain relatively unchanged but women take up behaviors in subsequent births that avert the risk of maternal death. In the last chapter, I combine population-representative data from the DHS with a village-level census (PODES) on service availability to understand how a village-level intervention to improve obstetric service use using a birth preparedness and complications readiness (BPCR) approach may improve obstetric service use. In this study, I find that the Desa Siaga intervention in Indonesia improved knowledge of the danger signs of complications among women but not among men relative to villages that did not get the program while controlling for endogenous program placement. More women got antenatal care due to the program but use of a skilled birth attendant and postpartum care did not change as a result of the intervention. Both genders report discussing a blood donor in preparation for delivery.</p> / Dissertation

Reproductive health patterns in post-Soviet Central Asian countries Abstract This study aims to evaluate reproductive health patterns among post-Soviet Central Asian republics since their independence. The reproductive health indicators of individual countries were researched and compared. Furthermore, cluster country groups among selected post-Soviet, post-Socialist and capitalist countries were identified based on certain reproductive health indicators for the beginning and the end of the research period. The subsequent research was focused on 1999 Kazakhstan Demographic and Health Survey data. This thesis explores statistically significant factors influencing pregnancy outcomes in the country. According to the results, never married, urban women, women of Ukrainian, Russian, and other ethnicities, women living in the East and North regions were more likely to terminate a first pregnancy by an induced abortion rather than giving a live birth. Additionally, the same categories were proven to be statistically significant using the Poisson regression analysis, except the regions were shown to be the West and the North. Keywords: post-Soviet Central Asia, reproductive health, maternal mortality, pregnancy outcomes