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Costa Rica reforms ‘model’ health care system
126 Midwifery the contraceptive prevalence rate stands at 4.8%, there is a high total fertility rate of between 6.8 and 7%. Restrictive abortion laws force many women with unwanted pregnancies to seek the services of unqualified practitioners practising in unsafe conditions. The problem began to be addressed after two studies showed that unsafe/illegal abortion was to be the leading cause of maternal mortality. A survey published in 1993 (Seyoum et al) estimated that up to 50% of gynaecological beds were occupied by women following abortion. A successful small-scale training programme set up in Addis Ababa by IPAS in 1992, to improve treatment of incomplete abortions and linkin with postabortion care family planning services, has now become a 2-year national postabortion care expansion plan.
IPAS Advances in Abortion Care, Volume 6 Number 1
The epidemiology of perinatal mortality In Pakistan perinatal data is primarily hospital based. Data from one large public hospital in Karachi indicates that approximately 60% of women admitted to the facility were referred because of obstetric complications. Due to the over-representation of delivery complications in hospitals, a population-based study was conducted to obtain epidemiological information on perinatal deaths that was representative of all pregnancies occurring within the population. The conclusion was that data from demographic surveys may be used to evaluate perinatal mortality. The perinatal mortality rate of 54.1 per 1000 total births, with an equal number of deaths in the late fetal and early neonatal periods, seemed reasonable. A further conclusion was that improvements in the educational and socioeconomic status of women are requisite for substantial reduction of perinatal mortality. One caution noted was that the deaths of female babies may be under-reported. In Jamaica perinatal statistics from hospital-based populations are frequently biased due to over-representation of women with high risk pregnancies. The perinatal mortality rate for the study period was 38 per 1000 total births. The prospective study used two overlapping samples of singleton births, all births occurring within a 2-month period, including all stillbirths weighing at least 500 grams and all neonatal deaths occurring over a 1-year period. Variables included characteristics of a socio-demographic nature as well as those of maternal health and maternal behaviour. Conclusions of this study were that, although cited as a reflection of socio-economic development, the mechanism of
perinatal mortality is unclear. Women of low socio-economic status were not at an increased risk for perinatal mortality and there was little variation in respect of maternal education. Conditions which jeopardize maternal survival, such as maternal infection, haemorrhage and hypertensive disorders are also major culprits of perinatal mortality which led the survey authors to recommend that all women have access to expert obstetric and paediatric care in an attempt to reduce perinatal mortality.
MotherCare Matters, Volume 6, No 3 August / September 1997
Midwife Ventouse practitioners Continuity and choice of care within community maternity units in Wiltshire (UK) is being revitalised as midwives take the initiative for midwife-led care. Recognition is given to medical staff becoming less able to provide intra-partum care for varying reasons. Many of the midwives have undertaken a 6-month training in Ventouse delivery: this enables them to apply a soft silicone suction cup to the baby's head to facilitate delivery. The instances for using this technique include maternal exhaustion or failure to progress in the second stage of labour. The advantages are that the women no longer face a wait for medical assistance to arrive or a 14 mile ambulance ride to the nearest consultant unit. The success of the project will be measured against satisfaction surveys from women and midwives; clinical audit of all Ventouse deliveries attempted and successfully undertaken; an analysis of transfers to the consultant unit and an increase in the number of women choosing to be delivered at the community unit.
Midwife-led care~Midwife Ventouse practitioners, Vicky Tinsley, Wiltshire Health Care NHS Trust
Costa Rica reforms 'model' health care system Currently Costa Rica has a health service which is the envy of many other wealthier countries. Infant mortality is low and a public network of urban and rural health centres serves the 3.5 million citizens. Reform is now in progress in recognition that the financial situation of many Latin American countries is not looking healthy and a financial strain on the health services of Costa Rica looks as if it could destroy the current effective service. Already outpatient clinics are stretched far beyond their limits and those citizens with fewer financial resources themselves are struggling to access the services. With the population
now living longer there is an increasing demand upon the services which are provided. Among teenagers, those with a high risk pregnancy and low birth weight babies receive special attention. Common backgrounds here are those of sexually transmitted diseases and of alcohol, tobacco and drug abuse. By reform and decentralising the approach to health care inequities can be targeted and a focal point here is to address the cantons where infectious diseases and pregnancy are associated with high death rates. Organising finance for the programme is by social security payments by the population through salaries, through charges for private health care and from central government sources.
World Health, Vo115 No 5 SeptemberOctober 1997
Key messages for communicators in communicating family planning in reproductive health A carefully programmed, ongoing set of activities involving a broad cross-section of society, not short-term promotional events, is identified by the World Health Organization as the best approach to effectively communicate family planning in reproductive health. Communicators should rely on a participatory approach to identify local needs and priorities to plan, develop, implement and evaluate effective strategies for disseminating information. The strategies to support the personnel skills needed for communication addressing aspects of the health of women, children and family well-being are extended to contraceptive choices and safety. Also encompassed in a small booklet is sexually transmitted disease prevention, the needs of adolescents and the responsibility of men in reproductive health. Communicating Family Planning in Reproductive Health - Key Messages for Communicators WHO/FRH/FPP/97.33
Female genital mutilation (FGM) in the UK Health workers, educationalists and staff from social services joined with representatives from cultural groups and organisations representing women, children and refugees at a forum held in December 1997 in London to discuss the issues, solutions, innovative ideas and evolving models of best practice in relation to FGM. Speakers presented community developments in refugee populations in Birmingham, the experience of women in Sierra Leone, the management of health related complications, the needs of young people in the community and inter-agency approaches.
IPAS Advances in Abortion Care, Volume 6 Number 1
The epidemiology of perinatal mortality In Pakistan perinatal data is primarily hospital based. Data from one large public hospital in Karachi indicates that approximately 60% of women admitted to the facility were referred because of obstetric complications. Due to the over-representation of delivery complications in hospitals, a population-based study was conducted to obtain epidemiological information on perinatal deaths that was representative of all pregnancies occurring within the population. The conclusion was that data from demographic surveys may be used to evaluate perinatal mortality. The perinatal mortality rate of 54.1 per 1000 total births, with an equal number of deaths in the late fetal and early neonatal periods, seemed reasonable. A further conclusion was that improvements in the educational and socioeconomic status of women are requisite for substantial reduction of perinatal mortality. One caution noted was that the deaths of female babies may be under-reported. In Jamaica perinatal statistics from hospital-based populations are frequently biased due to over-representation of women with high risk pregnancies. The perinatal mortality rate for the study period was 38 per 1000 total births. The prospective study used two overlapping samples of singleton births, all births occurring within a 2-month period, including all stillbirths weighing at least 500 grams and all neonatal deaths occurring over a 1-year period. Variables included characteristics of a socio-demographic nature as well as those of maternal health and maternal behaviour. Conclusions of this study were that, although cited as a reflection of socio-economic development, the mechanism of
perinatal mortality is unclear. Women of low socio-economic status were not at an increased risk for perinatal mortality and there was little variation in respect of maternal education. Conditions which jeopardize maternal survival, such as maternal infection, haemorrhage and hypertensive disorders are also major culprits of perinatal mortality which led the survey authors to recommend that all women have access to expert obstetric and paediatric care in an attempt to reduce perinatal mortality.
MotherCare Matters, Volume 6, No 3 August / September 1997
Midwife Ventouse practitioners Continuity and choice of care within community maternity units in Wiltshire (UK) is being revitalised as midwives take the initiative for midwife-led care. Recognition is given to medical staff becoming less able to provide intra-partum care for varying reasons. Many of the midwives have undertaken a 6-month training in Ventouse delivery: this enables them to apply a soft silicone suction cup to the baby's head to facilitate delivery. The instances for using this technique include maternal exhaustion or failure to progress in the second stage of labour. The advantages are that the women no longer face a wait for medical assistance to arrive or a 14 mile ambulance ride to the nearest consultant unit. The success of the project will be measured against satisfaction surveys from women and midwives; clinical audit of all Ventouse deliveries attempted and successfully undertaken; an analysis of transfers to the consultant unit and an increase in the number of women choosing to be delivered at the community unit.
Midwife-led care~Midwife Ventouse practitioners, Vicky Tinsley, Wiltshire Health Care NHS Trust
Costa Rica reforms 'model' health care system Currently Costa Rica has a health service which is the envy of many other wealthier countries. Infant mortality is low and a public network of urban and rural health centres serves the 3.5 million citizens. Reform is now in progress in recognition that the financial situation of many Latin American countries is not looking healthy and a financial strain on the health services of Costa Rica looks as if it could destroy the current effective service. Already outpatient clinics are stretched far beyond their limits and those citizens with fewer financial resources themselves are struggling to access the services. With the population
now living longer there is an increasing demand upon the services which are provided. Among teenagers, those with a high risk pregnancy and low birth weight babies receive special attention. Common backgrounds here are those of sexually transmitted diseases and of alcohol, tobacco and drug abuse. By reform and decentralising the approach to health care inequities can be targeted and a focal point here is to address the cantons where infectious diseases and pregnancy are associated with high death rates. Organising finance for the programme is by social security payments by the population through salaries, through charges for private health care and from central government sources.
World Health, Vo115 No 5 SeptemberOctober 1997
Key messages for communicators in communicating family planning in reproductive health A carefully programmed, ongoing set of activities involving a broad cross-section of society, not short-term promotional events, is identified by the World Health Organization as the best approach to effectively communicate family planning in reproductive health. Communicators should rely on a participatory approach to identify local needs and priorities to plan, develop, implement and evaluate effective strategies for disseminating information. The strategies to support the personnel skills needed for communication addressing aspects of the health of women, children and family well-being are extended to contraceptive choices and safety. Also encompassed in a small booklet is sexually transmitted disease prevention, the needs of adolescents and the responsibility of men in reproductive health. Communicating Family Planning in Reproductive Health - Key Messages for Communicators WHO/FRH/FPP/97.33
Female genital mutilation (FGM) in the UK Health workers, educationalists and staff from social services joined with representatives from cultural groups and organisations representing women, children and refugees at a forum held in December 1997 in London to discuss the issues, solutions, innovative ideas and evolving models of best practice in relation to FGM. Speakers presented community developments in refugee populations in Birmingham, the experience of women in Sierra Leone, the management of health related complications, the needs of young people in the community and inter-agency approaches.