Early termination of breast-feeding in periurban Santo Domingo, Dominican Republic: mothers' community perceptions and personal practices

The objectives of this study were to determine: 1) whether mothers' perceptions of typical community practice for breast-feeding duration influence their personal practices and 2) whether the mothers' reports of community reasons for terminating breast-feeding identify barriers not elicited through self-report. The study was conducted in 1997 in a sample of poor neighborhoods in a periurban district of Santo Domingo, the capital of the Dominican Republic. A representative sample of 220 mothers from these neighborhoods was interviewed with a structured questionnaire. While the duration of the brest-feeding was similar for self-report and for mothers' perceptions of typical community practice, there was no statistically significant correlation between these two variables. "Mother-driven" reasons for early termination of breast-feeding, such as "fear of loss of figure or breast shape" and " not wanting to breast-feed" were frequently perceived as community reasons but rarely given as personal reasons. Personal reasons were predominantly "child-driven," including " the child not wanting the breast," or reasons beyond the mothers' control such as having "insufficient" milk. Maternal report of community reasons for early termination may be a useful way to identify factors that would not otherwise be revealed on self-report. These additional reasons may guide health promotion efforts aimed at increasing breast-feeding duration (AU)

Informing maternal and child health (MCH) policy through research

Maternal and Child Health (MCH) policy over the past two decades has been strongly influenced by research. The paper presents examples of some of the research undertaken and its significant influence in shaping health service delivery. Research in child health has focussed on oral rehydration therapy, immunization and perinatal morbidity and mortality. On the maternal side, morbidity and mortality have been examined with particular focus on problems which contribute to maternal and perinatal morbidity and mortality. Policies arising out of the outcome of these studies have influenced organization of service delivery, information system development, manpower development and deployment, maternal education, surveillance/auditing, quality of care, design of physical facilites and selection of equipment. The results of these studies have also led to the identification of areas requiring further study and testing of intervention to correct the deficiencies identified. These studies demonstrate that research can and does influence health policy, and has impacted positively on the quality and cost of care provided through our health services.(AU)

Factors affecting the time at which pregnant women first attend antenatal clinic in an urban and a rural community in Jamaica

Maternal and child health services have been priority in Jamaica for at least seven decades. Studies have shown that early access to antenatal care by pregnant women will impact positively on the outcome of the pregnancy. This survey was carried out to identify factors affecting the time pregnant women first attend antenatal clinics, and the relationship that these factors have with variables such as age, union status and level of education. The sample of 145 was selected from pregnant women attending one rural and one urban health centre. The results revealed 54 percent of women surveyed attended antenatal clinic within the first 15 weeks of pregnancy. Age and level of education were not important determinants of time of first clinic attendance. The realization of the value of antenatal care per se, that is the minimizing of risk to the pregnant mother and foetus seemed the most important factor which influenced early antenatal clinic attendance. Facilitating factors for early attendance included shorter waiting hours, location of the health centre, the cost of the services and convenient clinic hours based on the individual's work schedule (AU)

The effect of maternal nutrition on foetal growth and blood pressure at age 2 years

This study was designed to examine the effects of maternal nutritional status on foetal growth and blood pressure at 2 years of age. It was a prospective study of women attending antenatal clinic at the University Hospital of the West Indies. 500 women attended the antenatal clinic and had six ultrasound measurements between 14 and 35 weeks gestation. The infants were followed at three-months intervals to 2 years. Main outcome measures were birth weight, head circumference, crown heel length, blood pressure. Measurements of the baby at birth were strongly related to maternal weight, BMI, weight gain in pregnancy (between 8 and 35 weeks), and triceps skinfold thickness. Relationships were strongest with booking weight and BMI. Women who weighed 55kg or less had the smallest, lightest babies and placentae. Placental volume was lower in the lighter women at both 17 and 20 weeks. Differences in abdominal circumference were not discernable until 35 weeks. The ratio of placental volume : abdominal circumference at 14 weeks as well as their relative rates of change between 14, 17 and 20 weeks gestation were different between the two groups of women. In the lighter women relative growth of placenta between 14 and 17 weeks was less than in the heavier women, suggesting poorer placental growth in underweight mothers. The data show that there is a relationship between maternal anthropometry, intrauterine growth, postnatal growth and blood pressure(AU)

Relationship between maternal nutritional status and infant's weight and body proportions at birth

OBJECTIVE: To examine maternal nutritional status and its relationship to infant weight and body proportions. DESIGN: Retrospective study of births from January-December 1990. SETTING: University Hospital of the West Indies, Jamaica. SUBJECTS: Records for 2394 live, singleton births, between 200-305 d gestation. MAIN OUTCOME MEASURES: Birth weight, crown heel length, head circumference, ponderal index, head circumference: length ratio, placental weight, placental: birth weight ratio. RESULTS: Mothers who were lighter had babies who had lower birth weight, were shorter, had smaller heads and had a higher HC:L ratio. Shorter and thinner women had babies who had lower birth wieghts, were shorter, had smaller heads and lighter placentas. Thinner women also had babies with a lower placental: birth weight ratio, and their BMI's were not linearly related to ponderal index and HC:L ratio. Women whose first trimester Hb levels were < 9.5 g/d1 had babies with the lowest birth weight, crown heel length, placental weight and ponderal index. These measurements increased as the Hb levels rose to 12.5 g/dl but then fell at Hb levels > 12.5 g/dl. In the second and third trimester Hb levels were negatively associated with birth weight, crown heel length, head circumference, placenta weight and ponderal index. CONCLUSIONS: The data support the hypothesis that poor maternal nutrition is associated with foetal growth restraint. Poor maternal nutrition as indicated by low weight, height, and BMI are associated with smaller, shorter babies with smaller heads. Haemoglobin levels > 12.5 g/dl in pregnancy are associated with lighter, shorter, thinner babies, with smaller heads.(AU)

Duration of maternal breast-feeding in the Dominican Republic

The study reported here explored the influence of maternal, health care, pregnancy, and child-related factors upon the duration of total breast-feeding (DTBF) in the Dominican Republic. The data for the study, which included 1984 mother-child pairs representative of the Domonican population, came in from the National HEalth Survey of 1991. The child in each of the mother-child pairs was the mother's last-born child who had been breast-fed and was less than three years of age at the time of the survey. Interviews with the mothers were used to collect information about the duration of breast-feeding and the factors studied (including maternal age, urban/rural residence, parity, mother's socioeconomic status, maternal education, maternal employment, mother's desire for pregnancy, type of delivery, the type of health worker attending the delivery, the child's sex, the child's birth weight, the time elapsed between delivery and initiation of breast-feeding, the child's age at complete weaning, and the child's age at the time of the survey)... According to the study results, the country's breast-feeding programs should give special attention to mothers with university educations, those giving birth in private health facilities, and those with low socioeconomic status giving birth to their first child, since these groups tended to breast-feed their children for relatively short periods of time. Also, breast-feeding promotion strategies should stress the importance of delaying the introduction of foods other than breast-milk into the child's diet, as this appears to be the one factor having the greatest adverse effect on the duration of breast-feeding (AU)

Coverage of maternity care: a listing of available information

All women should have access to basic maternity care during pregnancy and delivery. This includes quality antenatal care, clean and safe delivery whether the delivery takes place at home or in a health facility, as well as postpartum care for mother and infant. A continuum of care is essential for both mother and baby, aimed at improving their health and preventing morbidity and mortality. This document brings together, in a standard format, data on coverage of maternity care worldwide. The data presented have been collected from a variety of sources, including health service reporting and surveys. Country, regional and global estimates derived from the information available are presented. The estimated show that in the developing world only two in three women receive any antenatal care, less than 55 percent of deliveries are attended by skilled personnel and just 40 percent take place in health institutions. Thus, currently more than 45 million pregnant women annually do not receive any antenatal care, some 75 million births still take place at home and almost 60 million without a skilled attendant present. Between 90 and 100 million women do not receive postpartum care. South-central Asia and Western and Eastern Africa contribute heavily to these numbers, accounting for 45 percent of the world's births and also showing the lowest coverage of care during pregnancy and delivery. Whereas women who deliver with the assistance of skilled personnel have usually had at least one antenatal care visit, the reverse does not apply; many women who receive antenatal care do not have a skilled attendant present at delivery. Care is needed throughout delivery and the postpartum period which are prime opportunities to prevent ill health and avert deaths. Nearly all maternal deaths occur in developing countries and among the most disadvantaged population groups. Greater coverage of care during pregnancy, delivery and the postpartum period will help to reduce deaths and disabilities of mothers and infants

Relationship between maternal nutritional status and infant's weight and body proportions at birth

A retrospective study of births from January to December 1990 was conducted at the University Hospital of the West Indies, Jamaica. The study was restricted to 1794 live singleton infants between 38 and 42 weeks' gestation. The main outcome measurements were birthweight, crown-heel length, head circumference, ponderal index, and head circumference; crown-heel length ratio. Birthweight was found to be positively related to maternal weight, height, BMI, and age. Crown-heel-length and head circumference were also positively related to maternal age, weight, height, and BMI and there was a weak relationship with minimum haemoglobin in pregnancy. Ponderal index and head circumference: length ratio showed no significant relationship with maternal characteristics. The data support the hypothesis that poor maternal nutrition is associated with foetal growth restraint. Poor maternal nutrition as indicated by reduced weight, height and BMI is associated with lighter, shorter infants with smaller heads (AU)

Maternal morbidity: social and biological factors associated with maternal health status in the puerperium - abstract

While maternal mortality remains significant, maternal morbidity is a more widespread public health problem. During the Jamaican Perinatal Survey, midwives were asked to assess the mothers' health status, usually witin 48 hours of delivery. Of 10,380 mothers, 236 were considered ill, a morbidity prevalence rate of 2.4 percent when 11 others who died are included. These women were compared with those considered healthy to determine the significant social and biological risk factors associated with a poor puerperal health status evaluation, using multiple logistic regression. Considering social factors separately; being unemployed, using tobacco, living in the southern or south east region or in an urban area were significant. Women supported by a non-relative were a low-risk group. Significant pregnancy complications for primigravidae were the hypertensive disorders of pregnancy, oedema, bleeding at <28 weeks' gestation and diabetes. For multigravidae, a history of Caeseran Section, antepartum or postpartum haemorrhage and termination of the last pregnancy were predictors of ill health. For the current pregnancy, the hypertensive disorder, oedema and herpes infection were significant risk factors. Use of folate and unspecified over-the-counter drugs were protective. Significant intrapartum complications were: intrapartum hypertension, postpartum eclampsia, postpartum haemorrhage, use of analgesia (whether for vaginal delivery or Caeseran Section) and transfusion. Being unemployed, south east or southern region and urban area residence remained important social factors when obstetric complications (antenatal only) were modelled together with social and health service factors for all members combined. Most obstetrical history factors were explained by bleeding in early pregnancy, the hypertensive disorders and oedema. However, a previous Caseran birth continued to be significant. Early attendance for antenatal care was protective. Folate supplementation also entered the model with protective effect; however, this was not statistically significant (AU)

Traditional birth attendants, their training, and maternal health in Belize

A prospective case-series design and methodological approach which combined emic perspectives of ethnomedicine with etic measures of biomedicine were used to describe the obstetric concepts and practices of traditionally and biomedically trained traditional birth attendants (TBAs) and to determine if, and how, these TBAs differentially affect maternal health during parturition. Participants included one traditionally trained and one biomedically trained TBA (Case-Series TBAs) and 30 women living in Cayo and Orange Walk districts in Belize. Health histories and physical examinations of each woman were performed before and after parturition; timed observation of each TBA and woman was conducted after parturition. Lastly, a survey of concepts and practices of 26 TBAs (Survey TBAs) from these districts was conducted. Results show the Case-Series TBAs made significant contributions to maternal health during parturition through evaluation, support, and referral; however, certain interventions probably contributed to some impairment e.g., instructing women to bear down at apparent onset of active labor and exhaustion; assisted placental birth prior to signs of spontaneous separation and hemorrhage, with consequent anemia. The Case-Series TBAs shared most concepts and practices and had no differential effect on maternal health. Concepts appeared to be empirically derived but differed substantively from biomedical understandings; practices were viewed efficacious in terms of concepts and assessments of maternal health; both were generally widespread among the Survey TBAs. From this one can infer that TBAs in Cayo and Orange Walk districts make significant contributions to maternal health, yet may contribute to the impairments described; that exposure to biomedical obstetrics has had limited influence. Results suggest this is due to stability of the existing ethno-obstetric system. Traditional theory and therapy are reinforced because they are internally consistent, empirically derived, and perceived as efficacious by TBAs and women they attend. These findings are relevant to midwifery education and maternal health in Belize. The design and methodological approach were particularly useful for cross-cultural study of parturition and provided a framework for exploring interaction of biology and culture in the context of health.(AU)

Maternal determinants of perinatal mortality and of intrauterine growth retardation and preterm delivery

Marked disparities in rates of perinatal mortality continue to persist between developed and developing countries and even within developed countries. Major contributors to the differences across countries are the widely differing rates of preterm births and intrauterine growth retardation that are major determinants of perinatal mortality (1). Maternal conditions and factors play a major role in these adverse birth outcomes. This chapter highlights some of these, which include demographic factors, maternal diseases and conditions, social status, adverse health behaviors, and the use of prenatal care. Where possible, differences between developed and developing countries are highlighted. (AU)

Development of a culturally appropriate food guide for pregnant Caribbean immigrants in the United States

Communities with large Caribbean immigrant populations in Boston, Mass, have alarmingly high rates of both infant mortality and low-birth-weight infants. Although the federally funded Special Supplemental Food Program for Women, Infants, and Children (WIC) has been shown to increase infant birth weight and reduce fetal mortality, observations made in this study show that pregnant Caribbean immigrants who enrolled in WIC did not receive comprehensive, culturally appropriate nutrition counseling. Public health model as the basis for their dietary recommendations. The Basic Four model, however, is culturally biased and does not accomodate the food habits of the Caribbean immigrant. Furthermore, it does not adequately address the needs of pregnant women who are either lactose malabsorbers or vegetarians. Using ethnographic and nutrition science research methods, two culturally appropriate food guides were developed to accomodate the food practices of pregnant women from Haiti and the English-speaking Caribbean. The guides group food into three categories: growth, protection, and energy. The guides not only include cultural foods but allow for the Recommended Dietary Allowance (RDA) for calcium to be met by nondairy sources and the RDA for protein to be met by vegetable sources. This study suggests that the Basic Four system is an inadequate model for Caribbean immigrants and that it is possible and necessary to construct culturally appropriate food guides that meet the US RDAs. (AU)

Health services coverage of the young child and the pregnant woman

Presents an overview of the health services provisions for pregnant women by examining the criteria for assessing high-risk pregnancies; how the timing of antenatal visits differs by risk group; how the content and quality of antenatal care services differ across women at different risk levels; and the impact of antenatal care services on the frequency of hospital deliveries for high risk women. (AU)

Situational analysis of reproductive health in the Caribbean

Seeks to, provide an up-to-date picture of the status of reproductive health in the Caribbean; identify factors having the most critical impact upon reproductive health; and establish the priority areas for research and intervention in the region. Examines the concept of reproductive health to define the topic, the analytical framework and the methodology. Describes gender issues affecting reproductive health in the Caribbean, and presents the reproductive health status in the Caribbean, examining prevalent health problems and policy developments. Finally, identifies priority areas for research and intervention. (AU)