Abstract

PIP:

Data from the Reproductive Age Mortality Survey (RAMOS) help clarify the risk/benefit ratio of contraceptive use for health policymakers and family planners throughout the developing world. The province of Bali in Indonesia and the governorate of Menoufia in Egypt were selected as study sites due to their level of contraceptive prevalence, an expected number of deaths sufficient for analysis, and the liklihood of locating a high proportion of maternal deaths. Relative to population size, Bali has 74 times and Menoufia 48 times as many maternal deaths as the US. The study ran for the October 1980-September 1982 period in Indonesia and for the January 1981-December 1983 period in Egypt. The causes of death among women of reproductive age were similar in both countries. Complications of pregnancy, childbirth, and puerperium was the 1st cause of death in Bali and accounted for 23% of the deaths. In Menoufia pregnancy complications ranked second and accounted for 23% of the deaths. Diseases of teh circulatory system were another major cause of death in both areas, ranking first in Menoufia (28%) and third in Bali (13%). Reproductive mortality in both areas was dominated by maternal deaths; deaths related to contraceptive use were rare and found only among women over 30. In Bali a pregnancy and delivery carried 120 times the risk of death as a year of contraceptive use, and in Menoufia the risk of pregnancy and delivery was 48 times more likely to result in death than a year of contraceptive use. In Menoufia, contraceptive deaths over the 3 years of the study were estimated at 9 in 68,869 users of contraception, or 4.4/100,000 users per year. All of these deaths were attributed to oral contraception (OC). Reproductive mortality among married women aged 15-49 in Menoufia in 1981-83 was 45.9/100,000, of which 2% was attributed to contraception. Contraceptive deaths over the 2 years of the study in Bali were estimated at 8 in 188,241 users of contraception, or 2.0/100,000 users per year. 6 of the deaths were attributed to IUDs and 2 to OC. The reproductive mortality rate in Bali from 1980-82 was 68.2/100,000 married women, of which 1.5% was attributed to contraception. By comparison, the reproductive mortality rate in teh UK in 1975 was 3.5/100,000 women aged 25-44, of which 27% was attributed to contraception. Maternal mortality rates per 100,000 women of reproductive age was 35% higher in Bali than in Menoufia. Women in Menoufia with obstetric emergencies are more likely to reach the hospital or be seen by a physician. Many of the reproductive deaths occurring in both Menoufia and Bali are preventable but not necessarily with the programs and resources presently available in those areas. Increasing contraceptive use among women in both countries would have an immediate life saving impact. At the obstetric level, many of the deaths due to hemorrhage and sepsis could have been prevented had the deliveries occurred in hospitals with drugs and blood transfusions available. A smaller proportion of the eclamptic deaths could have been prevented given adequate prenatal care. Deaths from abortion would have been avoided by higher contraceptive prevalence.