Book Description

The Regional Reproductive Health Research Program conducts research on reproductive health issues as background for formulation of government action plans. Three completed studies are summarized and simplified in order to highlight their policy implications. Complete results will be available in separate volumes. The studies cover the following topics: risk factors for maternal mortality, patterns of contraceptive use, and factors influencing neonatal morbidity and mortality. Each study includes a discussion of rationales, objectives, results, general conclusions, and policy and program implications. For example, the rationale for the maternal mortality study was the lack of studies examining the influence of social, economic, and service factors on maternal mortality. The objectives were to examine risk factors (demographic and socioeconomic, obstetric and medical, health service related, and environmental) associated with hospital-based maternal mortality in Lesotho, Malawi, Uganda, and Zambia. The results of the case control study indicated 288 deaths among cases and 864 among controls. About 30% of mortality was attributed to complications from abortion. Important risk factors were identified as young age (under 17 years) and older age (over 35 years), lack of or lower level of education of the woman, and lower socioeconomic status. Maternal mortality was also related to the presence of medical complications in general and to life-threatening complications at the time of delivery, lower prenatal and health service care, and hospitalization occurring late in the birth process. Use of family planning was low and birth spacing very short among both cases and controls. A major finding was that women with severe complications were treated at home instead of at a health facility because of the cost of transportation. The policy implications of this study are that rural infrastructure needs to facilitate the movement of patients to health facilities or to move facilities closer to patients. Community teams need to be mobilized for transport in emergencies. Training enhancement of traditional birth attendants or greater use of doctors is needed.