Malcolm Potts

Maternal mortality in Indonesia and Egypt

Twenty‐three percent of deaths to women of reproductive age (15–49 years) in Bali, Indonesia and Menoufia, Egypt were due to maternal causes. Among the younger women, the percentage was even higher. In both areas complications of pregnancy and childbirth were a leading cause of death (the first cause in Bali, the second in Menoufia). In both sites, postpartum hemorrhage was the most common cause of maternal death. Relative to the United States, the number of maternal deaths per 100 000 live births was 20 times higher in Menoufia and 78 times higher in Bali. Families of women of reproductive age who died were interviewed about the conditions leading to death and other characteristics of the deceased. Completed histories were reviewed by a Medical Panel who were able to assign a cause of death in more than 90% of cases. Two‐thirds of the maternal deaths occurred to women who were over 30 and/or who had 3 children — the usual targets of family planning programs. Other possible intervention strategies include antenatal outreach programs, training of traditional birth attendants, and better hospital management of obstetric emergencies.

Performance of the copper T-380A intrauterine device in breastfeeding women

The effect of breastfeeding on performance of the TCu-380A IUD was evaluated using data derived from multicenter clinical trials. Insertion events for breastfeeding women (N = 559) and non-breastfeeding women (N = 590) were compared as well as discontinuations of IUD use through six months following insertion. Results indicate that breastfeeding women inserted with a TCu-380A are more likely than non-breastfeeding women to have a smooth, pain-free insertion, few postinsertion bleeding and pain problems, and a high rate of continuation of IUD use. There were no uterine perforations reported from either group of women.

Rare events associated with tubal sterilizations: an international experience.

The results from previous analyses of an international data set collected by Family Health International are reviewed in relation to the incidence, severity, risk factors, and outcomes of rare events associated with tubal sterilization. The rare events included for review, by sequence of their relationship to the tubal sterilization procedure are: luteal phase pregnancy, intraoperative complications (uterine perforation, unintended laparotomy required for completion of the laparoscopic procedure, and technical failure in tubal ring sterilization), deaths, early readmission following laparoscopic sterilization, hysterectomy after laparoscopic sterilization, and pregnancy (intrauterine and ectopic) conceived after tubal sterilization. The widespread use of this method of contraception has important public health implications, and awareness of these events will help clinicians minimize such incidences and better deal with them when they arise.

In‐hospital maternal mortality risk by cesarean and vaginal deliveries in two less developed countries—a descriptive study

Cesarean deliveries are increasing in both developed countries and less developed countries (LDCs). Recent studies in the U.S. have revealed a significantly higher mortality risk for women who delivered abdominally than for those who delivered vaginally, even when the effect of the conditions which necessitated cesarean delivery was taken into account. We chose for study from an international maternity monitoring network, five centers from two LDCs that reported an in‐hospital maternal mortality rate (MMR) of around 10 per 1000 parturient women. The pooled data revealed an MMR of 5.1 per 1000 women with vaginal deliveries. For women with cesarean delivery, the total MMR was 36.2 and the MMR attributable to cesarean section was estimated to be 12.8; both rates were per 1000 procedures. The leading cause of death was eclampsia for the vaginal deliveries and sepsis for the cesarean deliveries. The risk of maternal mortality inherent with the cesarean section procedure per se (not counting the risk associated with the labor and delivery complications that necessitated cesarean section) as well as the practical avoidability of maternal deaths for either mode of delivery in these LDC hospitals are discussed.

Methodological issues in collecting data from traditional birth attendants

Information on the activities, practices and social context of pregnancy and delivery care provided by traditional birth attendants (TBA) is a critical requirement in planning, monitoring and evaluating maternal health programs in many countries. As a result of experimental studies in which such information was obtained by a variety of methods, and a review of alternative methodologies, a set of guidelines has been developed for the collection of such information. Highlighted are the need for good background knowledge on the local situation, involving TBAs themselves in design and collecting methods, a system of supervision to ensure adequate training and careful monitoring and finally sharing the findings with the TBAs as well as with health officials.

Risks and costs of illegally induced abortion in Bangladesh

This article reports on women admitted to Dhaka Medical College Hospital for incomplete, illegally induced abortion. Women with low complication rates more often had abortions induced by medical practitioners. These women were younger, of lower parity and better educated than women having abortions initiated by other practitioners. Poorly educated women from slum areas almost always had an abortion induced by a nonmedical practitioner through the insertion of a solid object. These women experienced high complication rates and often required hysterectomies. This group also had high mortality rates. The drain on hospital resources needed to treat these abortion patients was great.

Menstrual therapies in Commonwealth Asian law.

Under English law, acting with the intention to procure an abortion whether a woman is pregnant or not is a crime. Laws in Commonwealth Asia governing abortion apply only in cases where a woman is clearly pregnant. Accordingly, menstrual therapies are available without violating abortion laws, or having to comply to their conditions. This permits doctors under such laws to exercise considerable discretion in recourse to menstrual therapies.

Paraguayan pharmacies and the sale of pseudo-abortifacients

This study was conducted in 1985 in Asunción, Paraguay, 6 years after the closure of the state supported family planning services. Data from national surveys in 1977 and 1987 permit a comparison of sources of contraceptive supplies before and after the elimination of government support for family planning. The purchase of pseudo-abortifacients from private pharmacies was used as an indication of induced abortion. After the loss of government clinics, it is suggested that some women turned to pharmacists to obtain pseudo-abortifacients when faced with unwanted pregnancy. There is an indication of increased pseudo-abortifacient use, particularly among unmarried women and those from poorer neighbourhoods.

Perspectives on fertility control

Potts M (International Fertility Research Program, Research Triangle Park, NC, USA). Perspectives on fertility control.

Drug approval and surveillance.

The author proposes that current regulations governing the licensing of drugs, particularly in the United States, need to be changed and replaced by a system of provisional or conditional licensing and increased postmarketing surveillance of drug use.