Rhonda Powell

The impact of violence against women on reproductive health and child mortality in Timor‐Leste

Objectives: To determine differences in reproductive health and infant and child mortality and health between abused and non‐abused ever‐married women in Timor‐Leste.

The structure and organisation of home-based postnatal care in public hospitals in Victoria, Australia : A cross-sectional survey

BACKGROUND There is limited evidence regarding the provision of home-based postnatal care, resulting in a weak evidence-base for policy formulation and the further development of home-based postnatal care services. AIM To explore the structure and organisation of public hospital home-based postnatal care in Victoria, Australia. METHODS An online survey including mostly closed-ended questions was sent to representatives of all public maternity providers in July 2011. FINDINGS The response rate of 87% (67/77) included rural (70%; n=47), regional (15%; n=10) and metropolitan (15%; n=10) services. The majority (96%, 64/67) provided home-based postnatal care. The median number of visits for primiparous women was two and for multiparous women, one. The main reason for no visit was the woman declining. Two-thirds of services attempted to provide some continuity of carer for home-based postnatal care. Routine maternal and infant observations were broadly consistent across the services, and various systems were in place to protect the safety of staff members during home visits. Few services had a dedicated home-based postnatal care coordinator. DISCUSSION AND CONCLUSION This study demonstrates that the majority of women receive at least one home-based postnatal visit, and that service provision on the whole is similar across the state. Further work should explore the optimum number and timing of visits, what components of care are most valued by women, and what model best ensures the timely detection and prevention of postpartum complications, be they psychological or physiological.

Male-biased sex ratios in Australian migrant populations: a population-based study of 1 191 250 births 1999-2015

Abstract Background The naturally occurring male-to-female (M/F) ratio at birth is 1.05. Higher ratios found primarily in countries across Asia have been attributed to prenatal sex selection due to son preference. There is growing evidence that sex-selective practices continue following migration; however, little is known about these practices following migration to Australia. Methods In this population-based study we assessed M/F ratios at birth per mother’s country of birth for all registered births 1999–2015 in Victoria, Australia (n = 1 191 250). We also compared the M/F ratio among births to mothers born elsewhere to that of mothers born in Australia, stratified by time period and parity. Results Compared with the naturally occurring M/F ratio as well as to the M/F ratio among births to mothers born in Australia, there was an increased ratio of male births to mothers born in India, China and South-East Asia, particularly at higher parities and in more recent time periods (elevated M/F ratios ranged from 1·079 to 1·248, relative risks of male birth ranged from 1·012 to 1·084 with confidence intervals between 1·001 and 1·160 and P-values between 0·005 and 0·039). The most male-biased sex ratios were found among multiple births to Indian-born mothers, and parity of two or more births to Indian and Chinese-born mothers in 2011–15. Conclusions The male-biased sex ratios observed in this study indicate that prenatal sex selection may be continuing following migration to Australia from countries where these practices have been documented. The excess of males among multiple births raises the question as to what role assisted reproduction plays. Findings also suggest that systematic discrimination against females starts in the womb.

Low overall mortality and morbidity for breech babies in the Netherlands

Sir We are concerned about the way Vlemmix et al. (1) represented the results of their study about the impact of increased rates of elective cesarean sections (ELCS) for breech presentation on neonatal outcomes. The authors identified a steady low rate of neonatal mortality associated with vaginal breech deliveries (VBD) in the Netherlands in 1999–2007 (1.6/1000 overall or 1.3/ 1000 for planned VBD) despite a large increase in the number of ELCS performed. This research adds to the growing body of retrospective data indicating significantly less risk of neonatal mortality for VBD than suggested by the term breech trial (TBT) (approximately 1:100) (2). The risk of neonatal mortality for planned VBD in this study is comparable to the risk of planning a vaginal birth after cesarean (VBAC) rather than an ELCS, an acceptable option that women are encouraged to consider in most European countries (3). Taken in context, the results therefore support the view that it would be reasonable for a larger proportion of women to attempt a VBD in their current pregnancy, rather than plan a VBAC in their next, particularly for first time mothers. Outcomes for babies may be further improved by the one thing the authors did not suggest: better training and approaches to the management of VBD. The authors call for the proportion of women who plan a VBD in the Netherlands (40%) to be reduced and for the Dutch national guidelines to be revised to exclude the fact that the 2-year outcomes in the TBT were no better for the ELCS group than for the planned VBD group (4). Given that women are concerned about the long-term effects for their children more than any other factor (5), this information should only be replaced by better, more contemporary research on 2-year and long-term outcomes. This study’s methodology does not justify its predictions about lives saved. It overestimates the risks of planned VBD because the category in this study absorbs risk from: