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WHAT'S NEW THIS THURSDAY: THREE ON MATERNAL AND NEONATAL MORTALITY REDUCTION

Wednesday, 11th of July 2012

 

• THREE ON MATERNAL AND NEONATAL MORTALITY REDUCTION
  
• MEETING CONTRACEPTION NEEDS COULD SINK MATERNAL DEATH RATE

The New York Times, 11 July 2012

A new study by researchers at Johns Hopkins University shows that fulfilling unmet contraception demand by women in developing countries could reduce global maternal mortality by nearly a third, a potentially great improvement for one of the world’s most vulnerable populations.

The study, published on Tuesday in The Lancet, a British science journal, comes ahead of a major family planning conference in London organized by the British government and the Bill and Melinda Gates Foundation that is an attempt to refocus attention on the issue. It has faded from the international agenda in recent years, overshadowed by efforts to combat AIDS and other infectious diseases, as well as by ideological battles.

The proportion of international population assistance funds that went to family planning fell to just 6 percent in 2008, down from 55 percent in 1995, while spending on H.I.V./AIDS represented 74 percent of the total in 2008, up from just 9 percent in 1995, according to Rachel Nugent, a professor of global health at the University of Washington, who cited figures from the United Nations Population Fund.

But population growth has continued to surge, with the United Nations estimating last year that the world’s population, long expected to stabilize, will instead keep growing. Population experts warn that developing countries, particularly those in sub-Saharan Africa, where fertility continues to be high and shortages of food and water are worsening, will face deteriorating conditions if family sizes do not shrink.

“Family planning kind of faded from the radar screen, and now it is coming back,” said John May, a visiting fellow at the Center for Global Development and author of a book, “World Population Policies: Their Origin, Evolution, and Impact.”

“There is a realization from many different places that population issues are not going away,” he said.

The issue of family planning is fraught in the United States, where government assistance often gets caught up in political battles. Contraception has again become controversial this political season, though the United States remains a major donor.

The Gates Foundation and the British government are pressing the issue. About $4 billion is expected to be pledged at the London conference to provide family planning services to 120 million women from the world’s poorest countries over the next eight years.

“We hear time and again from women out in the field that they want the ability to plan their families,” said Gary Darmstadt, director of family health at the Gates Foundation, who spoke by telephone from London. “We felt we needed to shine a light back onto the importance of this issue and get the conversation going.”

Maternal deaths have declined dramatically since 1990, down by a third, according to the World Health Organization.

But about 16 percent of the world’s population lives in countries where fertility is still more than four children per woman, Mr. May said. The numbers of people are expected to more than triple in these places during this century, an issue that is urgent not only for their economies and environment, but also for the women themselves, who women’s rights advocates argue would benefit from more power to decide about bearing children.

The Lancet study, which the Gates Foundation financed, draws on maternal mortality and survey data from the United Nations and World Health Organization to estimate the annual number of maternal deaths in 172 countries and the share that could be preventable by the use of contraception.

Birth control reduces health risks, the researchers said, by delaying first pregnancies, which carry higher risks in very young women; cutting down on unsafe abortions, which account for 13 percent of all maternal deaths in developing countries; and controlling dangers associated with pregnancies that are too closely spaced.

The authors of the Lancet study, researchers at the Bloomberg School of Public Health at Johns Hopkins, found that the number of maternal deaths in those countries in 2008 would have nearly doubled without contraception. They acknowleged, however, that maternal mortality record-keeping is weak in developing countries, a limitation of the study. They also found that an additional 29 percent of the deaths could have been prevented if women who wanted birth control would have received it, a concept called unmet need that is estimated using surveys of mothers in developing countries.

Even so, simply providing contraceptives to people who are not using them and who say they want to avoid pregnancy might not be enough to actually do so, and Professor Nugent said the study’s conclusions might be optimistic.

The lack of birth control in poor countries has become an important issue for Melinda Gates, who argued in highly personal remarks in April that birth control should not be controversial, because it improves women’s lives.

“Somewhere along the way we got confused by our own conversation and we stopped trying to save these lives,” she said. She added: “We’re not talking about abortion. We’re not talking about population control. What I’m talking about is giving women the power to save their lives.”

•  MATERNAL DEATHS AVERTED BY CONTRACEPTIVE USE: AN ANALYSIS OF 172 COUNTRIES

The Lancet 

outline goes here

The Lancet, Early Online Publication, 10 July 2012

Global Health; Obstetrics & Gynaecology (Contraception)

Original Text

Dr Saifuddin Ahmed PhD a , Qingfeng Li MA a, Li Liu PhD b, Prof Amy O Tsui PhD a

Background

Family planning is one of the four pillars of the Safe Motherhood Initiative to reduce maternal death in developing countries. We aimed to estimate the effect of contraceptive use on maternal mortality and the expected reduction in maternal mortality if the unmet need for contraception were met, at country, regional, and world levels.

Method

We extracted relevant data from the Maternal Mortality Estimation Inter-Agency Group (MMEIG) database, the UN World Contraceptive Use 2010 database, and the UN World Population Prospects 2010 database, and applied a counterfactual modelling approach (model I), replicating the MMEIG (WHO) maternal mortality estimation method, to estimate maternal deaths averted by contraceptive use in 172 countries. We used a second model (model II) to make the same estimate for 167 countries and to estimate the effect of satisfying unmet need for contraception. We did sensitivity analyses and compared agreement between the models.

Findings

We estimate, using model I, that 342 203 women died of maternal causes in 2008, but that contraceptive use averted 272 040 (uncertainty interval 127 937—407 134) maternal deaths (44% reduction), so without contraceptive use, the number of maternal deaths would have been 1·8 times higher than the 2008 total. Satisfying unmet need for contraception could prevent another 104 000 maternal deaths per year (29% reduction).

Interpretation

Numbers of unwanted pregnancies and unmet contraceptive need are still high in many developing countries. We provide evidence that use of contraception is a substantial and effective primary prevention strategy to reduce maternal mortality in developing countries.

Funding

Bill and Melinda Gates Foundation.

• EFFECTIVENESS OF EMERGENCY OBSTETRICAL

• Full text is at http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001264

From the editors’ summary:

What Do These Findings Mean?

These findings suggest that community mobilization interventions may reduce neonatal mortality and that maternity waiting rooms may reduce stillbirths. Importantly, they also highlight how referral interventions can have unexpected adverse effects. However, because the studies included in this systematic review included multiple interventions designed to reduce delays at several stages of the referral process, it is not possible to disentangle the contribution of each component of the intervention. Moreover, it is impossible at present to determine why (or even if) any of the interventions reduced maternal mortality. Thus, the researchers conclude, improved monitoring of interventions and better evaluation of outcomes is essential to inform the implementation of effective referral interventions, and more studies are needed to improve understanding of how referral interventions work.