A mortalidade materna é conhecida como um importante indicador de saúde relacionado à qualidade de vida e ao desenvolvimento de uma população, sendo considerada evitável em 95% dos casos. Apesar dos avanços tecnológicos, a mortalidade materna no nosso meio ainda não alcançou os níveis considerados aceitáveis pela Organização Mundial da Saúde (OMS). Estudo realizado em Porto Alegre, RS, mostrou que há um padrão muito heterogêneo de causas. Tais aspectos instigaram a realização deste estudo, cujos objetivos foram caracterizar a distribuição geográfica da mortalidade materna em Porto Alegre, segundo suas causas, características sócio-demográficas, obstétricas e tipo de serviço de saúde de referência em atenção primária, no período de 1999 a 2008. Foram estudados 96 casos correspondentes à totalidade dos óbitos maternos no período. Os dados foram obtidos no Sistema de Informação de Mortalidade (SIM) e Sistema de Informação sobre Nascidos Vivos (SINASC), complementados por busca em prontuários hospitalares e nos registros do Comitê Municipal de Estudos e Prevenção das Mortes Maternas (CMEPMM). Analisou-se a razão de morte materna (RMM), a RMM proporcional por grupos de causas, cor da pele [branca e não branca (preta, parda e amarela)], escolaridade, faixa etária e variáveis obstétricas O georreferenciamento foi realizado através da identificação do código de logradouros (CDL) dos endereços das declarações de óbito alocadas no território das gerências distritais do município. Os programas utilizados foram: Link Plus, Access e Excel 2003, ArcView Gis 3.2.a e Arc Explorer 2.0. Os resultados mostraram que a mortalidade materna no período foi de 47,84 óbitos/100.000 nascidos vivos (NV), com uma diminuição média de 3% ao ano. Entretanto, algumas causas estão aumentando, como SIDA e doenças clínicas. As principais causas foram as doenças clínicas, SIDA, doenças cardiovasculares (DCV) e a doença hipertensiva da gestação (DIHG). O risco de óbito foi maior para a faixa etária de 35 anos ou mais, para as mulheres com cor de pele não branca e com menor escolaridade, sendo de grande magnitude nas analfabetas. Todas as causas tiveram maior risco de óbito nas não brancas. As causas como aborto, hemorragia, infecção puerperal e SIDA, associadas às condições de maior vulnerabilidade social, foram mais importantes para as mulheres com cor de pele não branca, menor escolaridade e nas que não realizaram pré-natal. O georreferenciamento mostrou que há diferenças no risco de óbito materno, risco de óbito proporcional por tipo de causa (aborto, hemorragia, SIDA), escolaridade e cor de pele, identificando áreas de iniqüidades, mesmo dentro de regiões com melhor colocação no ranking do desenvolvimento humano municipal. Embora a mortalidade materna esteja reduzindo, seu perfil evidencia iniqüidades que necessitam de intervenções, tanto nos determinantes sociais quanto na qualidade da assistência à saúde. / Maternal mortality is known as a major health indicator related to quality of life and to population development, and it is considered avoidable in 95% of cases. Despite technological advances, maternal mortality in our country has not reached levels considered acceptable by the World Health Organization (WHO). A previous study in Porto Alegre, RS, showed a very heterogeneous pattern of causes. These aspects led to the present study, whose aims were to characterize the spatial distribution of maternal mortality in Porto Alegre according to sociodemographic and obstetrical causes and type of reference health services in primary care, during the period from 1999 to 2008. Ninety-six cases were studied, corresponding to the total number of maternal deaths between 1999 and 2008. The data were obtained from the SIM and SINASC systems, and complemented by looking at hospital charts and the records of the Municipal Committee of Studies and Prevention of Maternal Deaths (CMEPMM). Analyses were performed according to the maternal mortality ratio (MMR), proportional MMR according to groups of causes, skin color [white or nonwhite (black, brown and yellow)] schooling and age group, and some obstetrical variables. Georeferencing was performed by identifying street codes (código de logradouros –CDL) of territorialization areas of the municipal management districts. The programs used were Link Plus, Access and Excel 2003, ArcView Gis 3.2.a and Arc Explorer 2.0. The data showed that maternal mortality in Porto Alegre, was 47.84 deaths/100,000 live births (LB), and presented a mean reduction of 3% a year. However, some causes are increasing, such as AIDS and clinical diseases. The main causes were clinical diseases, AIDS, cardiovascular diseases (CVD), and hypertensive disorders of pregnancy (HDP). The risk of death was higher for the age group of 35 years or over, non-white skin color, less schooling, and higher in illiterate women. All causes presented a higher risk of death in non-white skin color. Causes such as abortion, hemorrhage, puerperal infection and AIDS, associated with greater social vulnerability, were more important for non-white women with less schooling and those who did not receive antenatal care. Geographic distribution allowed observing that there are differences in the risk of maternal death, risk of death proportional to type of cause (abortion, hemorrhage, AIDS), level of schooling, skin color, identifying areas of iniquity even within regions better placed in the ranking of municipal human development.. Although maternal deaths have been diminishing their profile shows iniquities that require intervention, both in social determinants and in improving the quality of health care.

Magister Public Health - MPH / Globally, 1600 women and over 5000 newborn babies die daily of preventable causes and over 90% of these deaths occur in developing world. An estimated 358000 maternal deaths occurred worldwide in 2008 with developing countries accounting for 99%. In Zambia, maternal mortality ratio has been estimated to be 591 deaths per I 00,000 live births underscoring the great challenge posed by maternal and child health problems. At the same time, utilization of antenatal care services by pregnant women, supervision of deliveries by skilled person and postnatal care services is low in most regions of Zambia. Since professional attendance at delivery is assumed to reduce maternal and infant mortality, poor antenatal care (ANC) utilization may lead to increased infant and matern.al mortality and morbidity.This study sought to assess the barriers to utilization of antenatal care services in Kazungula district, Zambia. A qualitative exploratory study was used to uncover participants' experiences and perceptions on barriers to use of ANC.Focus group discussions were used to gather information from primegravidae and multigravidae not attending or irregularly attending ANC services and from traditional birth attendants. In-depth interviews were conducted with key informants namely the health centre in-charge and leader of safe motherhood support group.Data was analyzed through thematic content analysis. From the transcripts, patterns of experiences coming from direct quotes or through paraphrasing common ideas forming part of the themes were listed. Data from all the transcripts relating to the classified patterns were identified and placed under the relevant theme. Thereafter related patterns were combined and listed into sub-themes. The analysis involved drawing together and comparing discussions of similar themes and examining how these relate to the variations between individuals and groups that assisted in understanding the phenomenon of interests. The study revealed that utilization of ANC was impeded by multiple interrelated factors such as low socio economic and educational status of women, influence of the older generation, traditional and cultural practices. Previous negative experiences with health workers such as bad attitude of health workers and perceived poor quality of care were mentioned as factors that negatively affect utilization of ANC services. Other notable barriers were built in confidence resulting from previous safe deliveries, family size and competing priorities, fear of being tested for HJY and physical the accessibility.The study recommends that the district and its partners address the barriers if efforts in safe motherhood will yield meaningful impact. DHMT in the long term plan needs to train and deploy skilled personnel to rural health centres. They should have a deliberate policy on rural incentives to motivate trained staff to remote areas. More health posts need to be built as a way of taking health care services as close to the family as possible. In addition, for the short term plan there is need to provide inservice training for staff on safe motherhood and circulate guidelines. Orient staff on focused antenatal care (FANC).DHMT should ensure continuum of, care by supporting adequate supplies, equipment, drugs and transport to the health facilities.

Ghana, a low-income developing country in sub-Saharan Africa is experiencing low maternal health service utilization and high rates of maternal mortality, especially in the rural areas. The Talensi-Nabdam District is one of the poorest and most remote districts in Ghana. The reproductive health status of women in the most remote communities in this District is poor. Dialogue about women’s reproductive health care needs in Ghana have been influenced by health care authorities, professionals, researchers and experts’ perceptions. The purpose of this ethnographic research was to explore rural Ghanaian women’s experiences of seeking reproductive health care from their own perspectives. The study was based on data collected from participant observations, unstructured face-to-face interviews and focus group discussions. A total of 27 women of varying socio-demographic backgrounds participated in the study. Interviews were conducted at locations of the women’s choice and in women’s local dialect. Data were translated and transcribed verbatim, and analyzed thematically. Four major themes emerged from the findings: submitting to the voices of family, women’s experiences of receiving nursing care, the community of gossip, and gaining voice. The findings of this study have implications for nursing practice, education and nursing inquiry. Awareness of barriers that rural women encounter in meeting their reproductive health care needs among health care providers is important in facilitating positive health care seeking behaviours. Nurse educators should orient themselves to the challenges to meeting women’s health care needs, and include in culturally sensitive approaches in nursing education programs. Further research is needed to investigate strategies that will enhance women’s reproductive health care seeking behaviours in rural settings and to focus on women’s perspectives in particular. In addition, research is needed to examine nurses’ perspectives on factors that influence quality care delivery to address women’s reproductive health issues.

Ghana, a low-income developing country in sub-Saharan Africa is experiencing low maternal health service utilization and high rates of maternal mortality, especially in the rural areas. The Talensi-Nabdam District is one of the poorest and most remote districts in Ghana. The reproductive health status of women in the most remote communities in this District is poor. Dialogue about women’s reproductive health care needs in Ghana have been influenced by health care authorities, professionals, researchers and experts’ perceptions. The purpose of this ethnographic research was to explore rural Ghanaian women’s experiences of seeking reproductive health care from their own perspectives. The study was based on data collected from participant observations, unstructured face-to-face interviews and focus group discussions. A total of 27 women of varying socio-demographic backgrounds participated in the study. Interviews were conducted at locations of the women’s choice and in women’s local dialect. Data were translated and transcribed verbatim, and analyzed thematically. Four major themes emerged from the findings: submitting to the voices of family, women’s experiences of receiving nursing care, the community of gossip, and gaining voice. The findings of this study have implications for nursing practice, education and nursing inquiry. Awareness of barriers that rural women encounter in meeting their reproductive health care needs among health care providers is important in facilitating positive health care seeking behaviours. Nurse educators should orient themselves to the challenges to meeting women’s health care needs, and include in culturally sensitive approaches in nursing education programs. Further research is needed to investigate strategies that will enhance women’s reproductive health care seeking behaviours in rural settings and to focus on women’s perspectives in particular. In addition, research is needed to examine nurses’ perspectives on factors that influence quality care delivery to address women’s reproductive health issues.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

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

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

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

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Este trabalho tem como objetivo compreender os símbolos atribuídos às tecnologias utilizadas na atenção obstétrica, como também conhecer as práticas femininas na busca por cuidados médicos na assistência ao parto. Para tanto, analisamos os relatos de 16 gestantes atendidas pelo setor privado e os de 13 gestantes assistidas pelo setor público. O estudo combinou duas técnicas qualitativas: a observação etnográfica e entrevistas semi-estruturadas. A pesquisa encontrou, entre outros, os seguintes resultados: 1-a maioria das mulheres observadas expressou a preferência pelo parto normal. 2- o nascimento, independente do tipo de parto desejado, está associado a categorias de medo, tensão e risco. 3- o discurso médico, segundo as gestantes atendidas pela rede privada, reforça a ansiedade e medo feminino e de sua família na medida em que associa o parto normal à dor e ao risco de morte. A cesariana, por outro lado, é descrita como um parto seguro. 4- na maternidade pública, as mulheres e seus acompanhantes vivenciaram o parto normal de maneira sofrida e passiva. 5- práticas profissionais compatíveis com a humanização do parto e as orientadas pelo modelo médico hegemônico, isto é, centrado na tecnologia na atenção ao nascimento, coexistem na rede pública. Contudo, a abordagem normativa ainda está presente em ambas as práticas. 6- a participação das parturientes nas decisões sobre o parto é escassa na rede pública. Em suma, concluímos que mulheres e médicos compartilham a visão de parto normal enquanto categoria de risco e a cesariana como prática segura. / This work aims to understand the symbols associated to technologies adopted in obstetric practice, and also women practices in searching for medical cares during childbirth. This study was carried out from June 2011 to October 2011 in 16 pregnant women attending the private hospitals and 13 pregnants attending public sector. I combined two qualitative techniques: Ethnographic observation and Semi-structured interview. I identified some ethnographic findings, such as: 1- most of women request for vaginal birth. 2. birth experience, regardless of delivery type desire, is associated with three categories: fear, tension and risk of death. 3-medical discourse, according to pregnant women attending private hospitals, reinforces womens and their families fear of pain and the risks of vaginal births. Cesarean birth, on the other hand, is described as a safe childbirth. 4- at the public maternity, I observed that women and their partners have experienced a painful and passive vaginal birth. 5- professional practices of humanized birth and medical intervention based on technologies in birth assistance, co-exist in public hospitals. However, normative approach is still on both practices. 6- the womens participation on childbirth decision is rare at the public health institution examined. In sum, our data suggest that both women and obstetricians share perception of the risks inherit in natural process of birth. Cesarean section, on the other hand, is being considered a fitting and safe form of childbirth.