Publication: Reducing Maternal Mortality : Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe
Loading...
Published
2003-04
ISSN
Date
2013-08-19
Author(s)
Editor(s)
Abstract
Of the 515,000 maternal deaths that occur every year worldwide, 99 percent take place in developing countries. Women In the developing world have a 1 in 48 chance of dying from pregnancy-related causes; the ratio in industrial countries is 1 in 1,800. Of all the human development indicators, the greatest discrepancy between industrial, and developing countries is in maternal health. The stimulus for this study was the question - Can current program strategies reduce maternal mortality faster that the decades required in the historically successful countries of Malaysia, and Sri Lanka? The answer was no. Based on case studies in seven selected countries, the study stipulates the factor common to all reviewed programs, is the high availability of a provider who is, either a skilled birth attendant, or closely connected with a capable referral system. A second common factor is the high availability of facilities that can provide basic, and essential obstetric care. But, unlike historic successes however, strong government policy now focuses explicitly on safe motherhood, and sets the tone for programs in most of the selected countries. Another difference between the case studies selected, and that in historically successful countries, is the financing of services: while service were free to families in Malaysia and Sri Lanka, costs of safe motherhood services are now substantial, and a major deterrent to use.
Link to Data Set
Citation
“Koblinsky, Marjorie A.. Koblinsky, Marjorie A., editors. 2003. Reducing Maternal Mortality : Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe. Health, Nutrition, and Population;. © World Bank. http://hdl.handle.net/10986/15163 License: CC BY 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication Better Reproductive Health for Poor Women in South Asia(World Bank, 2007-05)The overall purpose of this review is to bring attention to the opportunities that five countries in the region - Bangladesh, India, Nepal Pakistan and Sri Lanka have to strengthen and expand interventions to improve the reproductive health of poor women. The report's specific objectives are: 1) to provide an accurate picture of the current status of women's reproductive health and describe the use of reproductive health services and barriers to use; 2) to identify individual and household characteristics that affect reproductive health status and use of services; 3) to develop a simple and effective approach to decentralized health planning that can be used widely in each of the five countries to improve health service delivery and outcomes locally; and 4) to strengthen the case for investing in poor women's reproductive health by demonstrating the links between poverty, inequality and reproductive health. The review puts forth the following recommendations for reforms for reproductive health: to increase the supply of reproductive health services to poor women and adolescents by specifically targeting the poorest areas and households; to enhance demand among the poor for key services using BCC and demand-side financing; to integrate reproductive health services through a client-centered approach and strengthen weak services using specific relevant approaches; and to improve the reach, quality and status of women providers by better training, deployment and support are the 'frontline' improvements required for better reproductive health among poor women in South Asia.Publication The Potential for Integrating Community-Based Nutrition and Postpartum Family Planning : Review of Evidence and Experience in Low-Income Settings(World Bank, Washington, DC, 2013-11)The objective of this review was to study where community-based family planning and nutrition programs have been integrated, how this has been accomplished, and what the results have been. Although family planning is a nontraditional intervention in community-based nutrition programs, it can have profound effects on maternal and child health and nutrition. When family planning does not occur, short intervals between pregnancies deplete mothers' reserves of nutrients needed for pregnancy and later for breastfeeding. As a result, short birth intervals are associated with higher maternal and neonatal mortality and malnutrition rates of infants. Family planning, which promotes contraceptive use and the lactational amenorrhea method, can thus improve nutrition outcomes in both mothers and babies. The authors identified a few studies on integrated services in the published literature; thus the main part of the review is built on operational research studies and unpublished smaller scale intervention studies. However, the controlled studies that were identified indicate positive correlation between breastfeeding levels and increased contraception use. Additionally, although the design of the intervention studies did not make it possible to assess the degree to which integration had an impact, the studies did highlight factors that were key to a successful integration process. These are community engagement; multiple and frequent contact points between mothers, community volunteers, and health workers; involvement of husbands; moving implementation decisions closer to the users of the program; and assuring transparency, clarity, and simplicity in the transmission of development objectives to communities.Publication "...and then she died" : Indonesia Maternal Health Assessment(World Bank, 2010-02-01)Maternal health remains one of the top priorities of the Government of Indonesia (GoI) and the Ministry of Health (MoH) because reductions in maternal mortality have been slows. The current Maternal Mortality Ratio (MMR) for Indonesia is 228 but with existing programs and interventions the government does not believe it will be able to achieve its stated millennium development goal of 102 maternal deaths per 100,000 live births by 2015. There are positive trends in an increased use of skilled birth attendants, almost universal access to some level of antenatal care and continued use of family planning but these are not enough to stem the tide of maternal death. Interventions by the skilled birth attendants in many cases are not in line with existing standards and prove to be ineffective in trying to address the emergence of complications. Antenatal care is important, but it is not where gains in decreased mortality will be obtained. The continued use of traditional birth attendants (TBA) and delivering at home are contributory factors to maternal mortality in Indonesia. In collecting data from verbal autopsies in three districts, (a widely used government initiative to determine the causes of maternal death) 63 out of 76 deaths occurred in home births that had been assisted by a TBA. In order to improve the access of the poor and the near poor to health services, the government is implementing the social insurance scheme, Jamkesmas. Approximately 104 million people should qualify for assistance but there are presently only 76.4 million people covered by this social health insurance (SHI) plan. Even those who are covered are not always able to afford care because of external expenses such as transportation charges which must be paid up front.Publication Health, Nutrition, and Population in Madagascar 2000-09(World Bank, 2011-07-05)With an income per capita US$400 in 2008, Madagascar is one of the poorest countries in the world. Poverty is widespread but with significant urban-rural differences (52 percent versus 74 percent). Health, nutrition, and the fight against communicable diseases and HIV/AIDS are key goals of the country's poverty reduction strategy, the Madagascar Action Plan 2007-2012. The National Health Sector and Social Protection Development Plan 2007-2011 was developed to strengthen the health system and improve service delivery to reduce neonatal, child and maternal mortality, address malnutrition and control communicable illnesses. The health sector has benefited from increasing investment over the last years, and a number of studies and surveys have been carried out, providing a wealth of information that is yet to be analyzed in a complementary way. This Country Status Report (CSR) seeks to capitalize on all of the existing data in the health sector, compare Madagascar to countries of similar income levels and assess the results achieved by the health system. The CSR provides an analysis of the population's health and nutrition status by linking health outcomes, household/individual behaviors, community factors, government interventions, and service provision. Although Madagascar is performing beer than the SSA average of 645 per 100,000 live births, the maternal mortality rate has stagnated over the last decade and in 2008/09 was estimated at 498. Health care seeking behavior for preventive child health services at the health facility level is improving. Complete immunization coverage stands at 62 percent in 2008 (for children 12 to 23 months), but there are still large differences in coverage across regions, place of residence, and income groups.Publication Bangladesh Health Sector Profile 2010(Washington, DC, 2010-01)This health sector profile is a description of the health sector in Bangladesh, including its structure, resources, services, performance and dynamics. This document provides an overview of the sector, based on publicly available reports and data. The document intends to help the Ministry of Health and Family Welfare (MOHFW) and its partners to agree on the way forward and its respective roles in the process. It is neither an evaluation nor a programme review, rather it draws and extracts from these key documents to describe how the system works. Chapters one and two provide an overview on the health status of the people of Bangladesh and the determinants of health. Chapters three to eight summarise relevant aspects of the six health systems building blocks: the overall organisation of the health sector including governance and leadership; health services; human resources; information; financing; and medicines. Chapter nine summarises system reform aspects in the Health, Nutrition and Population Sector Programme (HNPSP) and work leading to the new draft national health policy. The annex provides a list of people consulted. The focus of the health sector profile is to describe how the sector works rather than how it should, or what has not happened in the past. The document offers no recommendations of its own in an attempt to leave open space for dialogue. To best serve this purpose, the profile describes all building blocks rather than only those areas where data and information are available. The expectation is that the profile will be updated periodically to fill existing gaps and reflect changes in the sector over time.
Users also downloaded
Showing related downloaded files
Publication Ten Steps to a Results-Based Monitoring and Evaluation System : A Handbook for Development Practitioners(Washington, DC: World Bank, 2004)An effective state is essential to achieving socio-economic and sustainable development. With the advent of globalization, there are growing pressures on governments and organizations around the world to be more responsive to the demands of internal and external stakeholders for good governance, accountability and transparency, greater development effectiveness, and delivery of tangible results. Governments, parliaments, citizens, the private sector, Non-governmental Organizations (NGOs), civil society, international organizations, and donors are among the stakeholders interested in better performance. As demands for greater accountability and real results have increased, there is an attendant need for enhanced results-based monitoring and evaluation of policies, programs, and projects. This handbook provides a comprehensive ten-step model that will help guide development practitioners through the process of designing and building a results-based monitoring and evaluation system. These steps begin with a 'readiness assessment' and take the practitioner through the design, management, and importantly, the sustainability of such systems. The handbook describes each step in detail, the tasks needed to complete each one, and the tools available to help along the way.Publication Universal Health Coverage for Inclusive and Sustainable Development : A Synthesis of 11 Country Case Studies(Washington, DC: World Bank, 2014-06-25)The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low income and middle-income countries (LMICs), where most of the world s poor live.Publication Rethinking School Feeding Social Safety Nets, Child Development, and the Education Sector(World Bank, 2009)This review highlights three main findings. First, school feeding programs in low-income countries exhibit large variation in cost, with concomitant opportunities for cost containment. Second, as countries get richer, school feeding costs become a much smaller proportion of the investment in education. For example, in Zambia the cost of school feeding is about 50 percent of annual per capita costs for primary education; in Ireland it is only 10 percent. Further analysis is required to define these relationships, but supporting countries to maintain an investment in school feeding through this transition may emerge as a key role for development partners. Third, the main preconditions for the transition to sustainable national programs are mainstreaming school feeding in national policies and plans, especially education sector plans; identifying national sources of financing; and expanding national implementation capacity. Mainstreaming a development policy for school feeding into national education sector plans offers the added advantage of aligning support for school feeding with the processes already established to harmonize development partner support for the education for all-fast track initiative.Publication Impact Evaluation in Practice, First Edition(World Bank, 2011)The Impact Evaluation in Practice handbook is a comprehensive and accessible introduction to impact evaluation for policymakers and development practitioners. The book incorporates real-world examples to present practical guidelines for designing and implementing evaluations. Readers will gain an understanding of the uses of impact evaluation and the best ways to use evaluations to design policies and programs that are based on evidence of what works most effectively. The handbook is divided into three sections: Part One discusses what to evaluate and why; Part Two outlines the theoretical underpinnings of impact evaluation; and Part Three examines how to implement an evaluation. Case studies illustrate different methods for carrying out impact evaluations.Publication Digital Africa(Washington, DC: World Bank, 2023-03-13)All African countries need better and more jobs for their growing populations. "Digital Africa: Technological Transformation for Jobs" shows that broader use of productivity-enhancing, digital technologies by enterprises and households is imperative to generate such jobs, including for lower-skilled people. At the same time, it can support not only countries’ short-term objective of postpandemic economic recovery but also their vision of economic transformation with more inclusive growth. These outcomes are not automatic, however. Mobile internet availability has increased throughout the continent in recent years, but Africa’s uptake gap is the highest in the world. Areas with at least 3G mobile internet service now cover 84 percent of Africa’s population, but only 22 percent uses such services. And the average African business lags in the use of smartphones and computers as well as more sophisticated digital technologies that catalyze further productivity gains. Two issues explain the usage gap: affordability of these new technologies and willingness to use them. For the 40 percent of Africans below the extreme poverty line, mobile data plans alone would cost one-third of their incomes—in addition to the price of access devices, apps, and electricity. Data plans for small- and medium-size businesses are also more expensive than in other regions. Moreover, shortcomings in the quality of internet services—and in the supply of attractive, skills-appropriate apps that promote entrepreneurship and raise earnings—dampen people’s willingness to use them. For those countries already using these technologies, the development payoffs are significant. New empirical studies for this report add to the rapidly growing evidence that mobile internet availability directly raises enterprise productivity, increases jobs, and reduces poverty throughout Africa. To realize these and other benefits more widely, Africa’s countries must implement complementary and mutually reinforcing policies to strengthen both consumers’ ability to pay and willingness to use digital technologies. These interventions must prioritize productive use to generate large numbers of inclusive jobs in a region poised to benefit from a massive, youthful workforce—one projected to become the world’s largest by the end of this century.