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Preventing maternal deaths
Health Policy, 13 (1989) 25 1-255 Elsevier
251
HPE 00305
Book Reviews
Preventing Maternal Deaths By E. Royston and S. Armstrong, (Eds.) World Health Organization, Geneva, 1989 233 pp., ISBN 92-4-156128-9, Sw.Fr. 40,-. I was immediately impressed when I opened this book. It is not only a scientific book, but a volume giving a vivid picture of the status of women today. First, the volume answers the questions; what is the problem? Where, why and how can we solve it? ‘... each year at least half a million women die from causes related to pregnancy and childbirth. Over 99% of maternal deaths take place in developing countries... and three-quarters of these deaths occur in South Asia: in India, Pakistan and Bangladesh... There are more maternal deaths in India in one day than there are in all the developed countries in one month. Most of the remaining deaths, some 150000 a year, occur in Africa’. The differences in maternal mortality rates between developing and developed countries indicate that most maternal deaths could be prevented. High maternal deaths in the third world are due to both the lag in economic development and to the woman’s status, especially the latter. In many societies women are treated as birth-machines and give birth too often, too early, too late, and too close together. Because women are treated as machines, there is no need for education or health care. In fact, in some cases, women are treated worse than machines; good .workers at least take good care of their machines, but often women get poor treatment. This poor treatment often leads to malnutrition, chronic fatigue, and, finally, high maternal deaths. The importance of deaths resulting from abortion complications must be emphasized. Many women reported they did not want any more children, but less than half of those women were using contraception. The discrepancy was most pronounced in Africa, where an average of only 23% of the women who wanted no more children were using contraception, as compared with 43% in Asia and 57% in Latin America. Thus, the contraceptive services do not meet the women’s demands; consequently, they often have to suffer induced abortions, and sometimes have to use ‘back-street’ abortion facilities. Therefore, it is not difficult to understand why there are between 114900-204 450 abortion-related deaths each year. These are the vivid and clear pictures that this volume provides the readers. The volume also shows that there are at least two interventions that would help solve the problem. ‘We know already how to prevent most common ultimate causes that can lead to maternal death, such as eclampsia, obstructed labour, haemorrhage, or sepsis. The fact that these have become rarities in the industrialized world, in some developing countries and in all but some rural areas of China, proves conclusively that we now know enough to act effectively now’. This paragraph made me recall a visit to Beijing by foreign visitors and the criticism they gave; they said ‘Barefoot doctors are not doctors; what degree do they have?’ Yes, that is true, they have no medical degree, but they have a basic training and are able to do primary health care. As everyone knows, China is such a huge country that it might take hundreds of years to get enough medical-school trained doctors to meet the nation’s health needs. Thus we have a choice: do we wait for hundreds of years to get basic medical care for all, or do we use barefoot doctors? The Chinese have chosen the latter, and health statistics from China indicate that barefoot doctors are much much better than nothing. As described in this volume: ‘Like pure water and like nutritious food, family planning is essential for good health’. 0168-8510/89/$03.50 0 1989 Elsevier Science Publishers
B.V. (Biomedical
Division)
252 Evidence shows that a large proportion of maternal deaths is due to women giving birth too often, too early, too late, and too close together. Family planning can help to prevent these deaths. However, there are some ‘humanisms’ who oppose abortion, who always close their eyes, and sing ‘protect life’ loudly. It seems that they are mostly concerned with their own lives. I would like to ask these people: ‘When you see a woman go to a back-street in Asia to get a terrible abortion, then where is your ‘humanism’?’ It is also clear that women in all countries. developed and developing, need access to safe and affordable abortions, without such access, many will have to resort to dangerous ‘back-street’ abortions. This volume uses a large body of facts to cry out: ‘People, do your best to save women’s lives, women are your mothers, sisters, wives and daughters.’ From the point of research, this volume offers some simple and easy indicators such as sex ratio of reproductive, age mortality rates, index of son preference, etc. This book would have been strengthened with the inclusion of case studies which would give the reader a better understanding of the countries or areas where the maternal mortality is high. In summary, this book is very useful for people who work in public health, family planning, maternal-child health care, and human rights. Professor S. Wang Department of Health Statistics and Medical Demography Beijing Medical University Beijing, The People’s Republic of China
*****
General Practice and Primary Health Care 194Os-1980s By J. Fry The Nuffield Provincial Hospitals Trust, London, 1988 116 pp., ISBN 0-900574-69-O This little book, of 115 pages, is a gem, and I would recommend it for any general practitioner/family physician who is interested in the history and background of his/her profession, but in particular, developed or developing countries who are looking for direction in implementing their own primary health care program. The book starts with a definition of general practice and primary health care, and then summarizes the background of British general practice from 1750 to 1948 and the national health service from 5 July 1948 and thereafter. Dr. Fry then contrasts the changing trends in society, with changing trends and data of general practice, and quite accurately depicts general practice in the United Kingdom. The final chapter, ‘at the Crossroads of Time: Future Hopes, Qualms and Dilemmas’, is worth the book itself. Dr. Fry projects what’s to be done, who might do it, how it should be done, how to administer well and give better value for money, how to achieve changes, future hopes and needs, the insoluble equation examined, general practice, what may happen, and an agenda for the future. This book should provide good reading for medical students, practislng physicians, faculties and for health care planners.
Talking and Listening to Patients. A Modern Approach By C. Fletcher and P. Freeling The Nuffield Provincial Hospitals Trust, London, 1988 68 pp., ISBN o-900574-70-4 This small book is primarily
a how-to-interview
book and discusses
the interview,
reasons
and
251
HPE 00305
Book Reviews
Preventing Maternal Deaths By E. Royston and S. Armstrong, (Eds.) World Health Organization, Geneva, 1989 233 pp., ISBN 92-4-156128-9, Sw.Fr. 40,-. I was immediately impressed when I opened this book. It is not only a scientific book, but a volume giving a vivid picture of the status of women today. First, the volume answers the questions; what is the problem? Where, why and how can we solve it? ‘... each year at least half a million women die from causes related to pregnancy and childbirth. Over 99% of maternal deaths take place in developing countries... and three-quarters of these deaths occur in South Asia: in India, Pakistan and Bangladesh... There are more maternal deaths in India in one day than there are in all the developed countries in one month. Most of the remaining deaths, some 150000 a year, occur in Africa’. The differences in maternal mortality rates between developing and developed countries indicate that most maternal deaths could be prevented. High maternal deaths in the third world are due to both the lag in economic development and to the woman’s status, especially the latter. In many societies women are treated as birth-machines and give birth too often, too early, too late, and too close together. Because women are treated as machines, there is no need for education or health care. In fact, in some cases, women are treated worse than machines; good .workers at least take good care of their machines, but often women get poor treatment. This poor treatment often leads to malnutrition, chronic fatigue, and, finally, high maternal deaths. The importance of deaths resulting from abortion complications must be emphasized. Many women reported they did not want any more children, but less than half of those women were using contraception. The discrepancy was most pronounced in Africa, where an average of only 23% of the women who wanted no more children were using contraception, as compared with 43% in Asia and 57% in Latin America. Thus, the contraceptive services do not meet the women’s demands; consequently, they often have to suffer induced abortions, and sometimes have to use ‘back-street’ abortion facilities. Therefore, it is not difficult to understand why there are between 114900-204 450 abortion-related deaths each year. These are the vivid and clear pictures that this volume provides the readers. The volume also shows that there are at least two interventions that would help solve the problem. ‘We know already how to prevent most common ultimate causes that can lead to maternal death, such as eclampsia, obstructed labour, haemorrhage, or sepsis. The fact that these have become rarities in the industrialized world, in some developing countries and in all but some rural areas of China, proves conclusively that we now know enough to act effectively now’. This paragraph made me recall a visit to Beijing by foreign visitors and the criticism they gave; they said ‘Barefoot doctors are not doctors; what degree do they have?’ Yes, that is true, they have no medical degree, but they have a basic training and are able to do primary health care. As everyone knows, China is such a huge country that it might take hundreds of years to get enough medical-school trained doctors to meet the nation’s health needs. Thus we have a choice: do we wait for hundreds of years to get basic medical care for all, or do we use barefoot doctors? The Chinese have chosen the latter, and health statistics from China indicate that barefoot doctors are much much better than nothing. As described in this volume: ‘Like pure water and like nutritious food, family planning is essential for good health’. 0168-8510/89/$03.50 0 1989 Elsevier Science Publishers
B.V. (Biomedical
Division)
252 Evidence shows that a large proportion of maternal deaths is due to women giving birth too often, too early, too late, and too close together. Family planning can help to prevent these deaths. However, there are some ‘humanisms’ who oppose abortion, who always close their eyes, and sing ‘protect life’ loudly. It seems that they are mostly concerned with their own lives. I would like to ask these people: ‘When you see a woman go to a back-street in Asia to get a terrible abortion, then where is your ‘humanism’?’ It is also clear that women in all countries. developed and developing, need access to safe and affordable abortions, without such access, many will have to resort to dangerous ‘back-street’ abortions. This volume uses a large body of facts to cry out: ‘People, do your best to save women’s lives, women are your mothers, sisters, wives and daughters.’ From the point of research, this volume offers some simple and easy indicators such as sex ratio of reproductive, age mortality rates, index of son preference, etc. This book would have been strengthened with the inclusion of case studies which would give the reader a better understanding of the countries or areas where the maternal mortality is high. In summary, this book is very useful for people who work in public health, family planning, maternal-child health care, and human rights. Professor S. Wang Department of Health Statistics and Medical Demography Beijing Medical University Beijing, The People’s Republic of China
*****
General Practice and Primary Health Care 194Os-1980s By J. Fry The Nuffield Provincial Hospitals Trust, London, 1988 116 pp., ISBN 0-900574-69-O This little book, of 115 pages, is a gem, and I would recommend it for any general practitioner/family physician who is interested in the history and background of his/her profession, but in particular, developed or developing countries who are looking for direction in implementing their own primary health care program. The book starts with a definition of general practice and primary health care, and then summarizes the background of British general practice from 1750 to 1948 and the national health service from 5 July 1948 and thereafter. Dr. Fry then contrasts the changing trends in society, with changing trends and data of general practice, and quite accurately depicts general practice in the United Kingdom. The final chapter, ‘at the Crossroads of Time: Future Hopes, Qualms and Dilemmas’, is worth the book itself. Dr. Fry projects what’s to be done, who might do it, how it should be done, how to administer well and give better value for money, how to achieve changes, future hopes and needs, the insoluble equation examined, general practice, what may happen, and an agenda for the future. This book should provide good reading for medical students, practislng physicians, faculties and for health care planners.
Talking and Listening to Patients. A Modern Approach By C. Fletcher and P. Freeling The Nuffield Provincial Hospitals Trust, London, 1988 68 pp., ISBN o-900574-70-4 This small book is primarily
a how-to-interview
book and discusses
the interview,
reasons
and