This is an overview of evidence of the effectiveness of antenatal care in relation to maternal mortality and serious morbidity, focused in particular on developing countries. It concentrates on the major causes of maternal mortality, and traces their antecedent morbidities and risk factors in pregnancy. It also includes interventions aimed at preventing, detecting or treating any stage along this pathway during pregnancy. This is an updated and expanded version of a review first published by the World Health Organization (WHO) in 1992. The scientific evidence from randomised controlled trials and other types of intervention or observational study on the effectiveness of these interventions is reviewed critically. The sources and quality of available data, and possible biases in their collection or interpretation are considered. As in other areas of maternal health, good-quality evidence is scarce and, just as in many aspects of health care generally, there are interventions in current practice that have not been subjected to rigorous evaluation. A table of antenatal interventions of proven effectiveness in conditions that can lead to maternal mortality or serious morbidity is presented. Interventions for which there is some promising evidence, short of proof, of effectiveness are explored, and the outstanding questions formulated. These are presented in a series of tables with suggestions about the types of study needed to answer them.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-3016.2001.0150s1001.x

How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence

Where is the "E" in MCH? The need for an evidence-based approach in safe motherhood.

Objective: This study evaluates the effectiveness of a set of information, education, and communication (IEC) strategies designed to increase the awareness of danger signs in pregnancy, delivery, or the postpartum period among pregnant or recently pregnant women. Methods: Three IEC programs were implemented in 4 regions of southwestern Guatemala between April 1997 and May 1998: (1) a clinic-based program involving the training of health providers in prenatal counseling and the provision of educational media to clients; (2) a community-based strategy consisting of radio messages regarding obstetric complications; and (3) educational sessions conducted through women's groups. Three surveys were conducted. In 1997, 637 pregnant women were interviewed at clinics where the interventions had been implemented. In 1998, 163 pregnant women using a subset of the same health clinics were interviewed. In 1999, a population-based survey of 638 pregnant and postpartum women was conducted. Using logistic regression, we model awareness of danger signs as a function of sociodemographic characteristics, prenatal care utilization, and IEC interventions. Results: Among women using health clinics, the likelihood of having heard of danger signs nearly tripled between 1997 and 1998, when the clinic interventions were fully implemented. In 1999, those who had heard radio messages or participated in women's groups were, respectively, 3 times and 5 times more likely to have heard of danger signs in pregnancy. Conclusions: Safe motherhood programs can effectively increase knowledge of danger signs through clinic- and community-based educational strategies.

Increasing awareness of danger signs in pregnancy through community- and clinic-based education in Guatemala.

Off to a rapid start: appraising maternal mortality and services.

Reproductive health (RH) research using the Situation Analysis approach an assessment of the availability and quality of services has proven popular and useful in Africa where more than 25 such studies were implemented during the 1990s. Since the first study in Kenya in 1989 Situation Analysis methodology has evolved from a narrow focus on family planning to cover all reproductive health services. This report describes a 2002-2003 study in KwaZulu Natal that expanded the methodology to cover important HIV/AIDS-related issues including: The availability and quality of voluntary counseling and testing (VCT) services. The extent of integration of family planning (FP) antenatal care (ANC) and sexually transmitted infection (STI) services with HIV prevention. The extent of condom promotion and other HIV prevention strategies. The goal of the study was to obtain information from a representative sample of provincial health care facilities in KwaZulu Natal offering RH services to identify gaps in service delivery and determine priorities for integration to meet the growing demand for HIV/AIDS-related services. (excerpt)

/pdf/reproductive-health-services-in-kwazulu-natal-south-africa-a-giyh7g00gf.pdf

Reproductive health services in KwaZulu Natal, South Africa: A situation analysis study focusing on HIV/AIDS services

Conference proceedings on reassessing the concept of reproductive risk in maternity care and family planning (FP) services cover the following topics: assessment of the history of the concept of reproductive risk the epidemiology of screening the implementation of the risk approach in maternity care in Western countries and in poorer countries and in FP the possible effects on the health care system costs and risk benefit calculations. Other risk approaches and ethical considerations are discussed. The conclusions pertain to costs and allocation of resources information and outreach objectives predictive ability and risk assessment in FP. Recommendations are made. Appendixes include a discussion of issues involved in developing a reproductive risk assessment instrument and scoring system and the WHO risk approach in maternal and child health and FP. The results show that the application of risk assessment warrants caution and usefulness in service delivery is questionable. The weaknesses and negative effects need further investigation. Risk-based systems tend toward skewed resource allocation. Equal access to care freedom of choice and personal autonomy are jeopardized. Risk assessment can accurately predict for a group but not for individuals. Risk assessment cannot be refined as it is an instrument directed toward probabilities. The risk approach must be evaluated within a functioning health care system. Screening has been important in developed countries but integration into developing country health care systems may be appropriate only when basic health care is in place and in urban and periurban communities. Recommendations are 1) to prevent problems and detect rather than predict actual complications when no effective maternity care is available; to provide effective care to all women not just those at high risk; and to provide transportation to adequate facilities for women with complications. 2) All persons attending births should be trained to handle emergencies. 3) Risk assessment has no value unless basic reproductive health services are in place. Cost benefit analysis precludes implementation. Alternative strategies are available to increase contact of women with the health care system to improve public education strategies to improve the quality of traditional birth attendants and to improve the quality of existing services. Womens ideas about what is "risk" and the cost and benefits of a risk-based system to women needs to be solicited. All bad outcomes are not preventable. Copies of this document can be obtained from The Population Council One Dag Hammarskjold Plaza NY NY 10017. Tel: (212) 339-0625 e-mail vkallianes@popcouncil.org.

A reassessment of the concept of reproductive risk in maternity care and family planning services. Proceedings of a seminar presented under the Population Councils Robert H. Ebert Program on Critical Issues in Reproductive Health and Population February 12-13 1990 the Population Council New York New York.

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