Obstetric Care in Poor Settings in Ghana, India, and Kenya
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World Bank, Washington, DC
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Women are at much greater risk in
childbirth in developing countries than in developed
countries. This report explores why maternal mortality
continues to be so high in developing countries, and why
emergency obstetric services are little utilized, through
research carried out in poor areas in Ghana (Kassena-Nankana
district), India (Uttar Pradesh state), and Kenya (Nairobi
slums). The study employed both quantitative (household
surveys, verbal autopsies, and health facilities surveys)
and qualitative (focus groups and in-depth interviews)
methods. Among the three settings, maternal mortality ratio
was highest in the Nairobi slums, followed by Uttar Pradesh,
while the Kassena- Nankana district had the lowest. It is
intriguing that among the three settings, Nairobi slums had
the highest proportion of women (70 percent) who sought
professional assistance during delivery and yet the highest
maternal mortality. One possible explanation is the
different extent of legality of induced abortion in these
three countries. Of the major causes of maternal mortality,
the largest contrast among the study areas involved
complications of abortion, which were almost four times
higher in the Kenya slums than in the north of Ghana or in
Uttar Pradesh. A large proportion of health facilities
assessed in the three study areas were not capable of
providing all six elements of basic emergency obstetric care.
Palabras clave
ABORTION, HEALTH SYSTEM, HEALTH WORKERS, HIV, HOSPITAL, HOSPITALS, HOUSEHOLD SURVEYS, HUMAN DEVELOPMENT, HUSBANDS, HYPERTENSION, HYPOTHERMIA, ILLITERACY, ILLITERACY RATE, ILLNESS, IMMUNIZATIONS, IMMUNODEFICIENCY, INFECTIOUS DISEASES, INFERTILITY, INFORMATION SYSTEMS, INFORMED DECISIONS, INTERNATIONAL COMMUNITY, INTERNATIONAL CONFEDERATION OF MIDWIVES, INTERNATIONAL CONSENSUS, KNOWLEDGE BASE, LABOR FORCE, LEADING CAUSES, LEADING CAUSES OF DEATH, LIFE EXPECTANCY, LIFETIME RISK, LIVE BIRTHS, LIVELIHOOD OPPORTUNITIES, LOW-INCOME SETTINGS, MALARIA, MATERNAL CARE, MATERNAL CAUSES, MATERNAL DEATH, MATERNAL DEATHS, MATERNAL HEALTH, MATERNAL HEALTH CARE, MATERNAL HEALTH SERVICES, MATERNAL MORBIDITY, MATERNAL MORTALITY, MATERNAL MORTALITY RATE, MATERNAL MORTALITY RATIO, MATERNAL MORTALITY RATIOS, MATERNITY CARE, MATERNITY HOSPITAL, MEDICAL CARE, MEDICAL FACILITIES, MEDICAL FACILITY, MEDICATION, MIDWIFE, MILLENNIUM DECLARATION, MILLENNIUM DEVELOPMENT GOAL, MILLENNIUM DEVELOPMENT GOALS, MINISTRY OF HEALTH, MISSION HOSPITAL, MORBIDITY, MORTALITY, MOTHER, NUMBER OF WOMEN, NURSE, NURSES, NURSING, NURSING HOMES, NUTRITION, OBSTETRIC CARE, OBSTETRIC COMPLICATIONS, OBSTETRIC EMERGENCIES, OBSTETRIC FACILITIES, OBSTETRIC FISTULA, OPINION LEADERS, PANDEMIC, PHARMACIES, PHYSICIANS, POLICY FORMULATION, POLICY IMPLICATIONS, POOR WOMEN, POPULATION GROWTH, POPULATION GROWTH RATE, POST-ABORTION, POST-ABORTION CARE, POSTABORTION, POSTABORTION CARE, POSTNATAL CARE, POSTPARTUM PERIOD, PREGNANCIES, PREGNANCY, PREGNANCY OUTCOME, PREGNANCY OUTCOMES, PREGNANCY-RELATED CAUSES, PREGNANT WOMAN, PREGNANT WOMEN, PRENATAL CARE, PRIVATE CLINIC, PROGRESS, PROPHYLAXIS, PUBLIC AWARENESS, PUBLIC DEBATE, PUBLIC HEALTH, QUALITATIVE INFORMATION, QUALITY OF CARE, REDUCING MATERNAL MORTALITY, REGISTRATION SYSTEMS, REPRODUCTIVE AGE, REPRODUCTIVE HEALTH, REPRODUCTIVE HEALTH INDICATORS, REPRODUCTIVE HEALTH SERVICE, RISK FACTORS, RURAL AREAS, RURAL DISTRICT, RURAL WOMEN, SAFE ABORTION, SAFE ABORTION SERVICES, SANITATION, SCHOOLS, SEXUAL INTERCOURSE, SKILLED ATTENDANTS, SOCIOECONOMIC DEVELOPMENT, SOCIOECONOMIC STATUS, SPONTANEOUS ABORTION, SPOUSES, STATUS OF WOMEN, SUBSISTENCE FARMING, TELEVISION, TERMINATION OF PREGNANCY, TRADITIONAL BELIEFS, TRADITIONAL BIRTH ATTENDANTS, TUBERCULOSIS, UNFPA, UNITED NATIONS POPULATION FUND, UNSAFE ABORTION, UNWANTED PREGNANCY, URBAN CENTERS, USE OF MATERNAL HEALTH SERVICES, VAGINAL DELIVERY, VIOLENCE, VITAL STATISTICS, WOMAN, WOMEN WITH ABORTION COMPLICATIONS, WORKERS, WORLD HEALTH ORGANIZATION, YOUNG WOMEN