The prevention of preterm delivery through prenatal care: an intervention study in Martinique.

During 1976-1978, improvements were made in the free prenatal care provided by the maternal and child health authority (PMI) of Martinique. Central to these changes was implementation of a program of preventive prenatal care developed in France by one of the authors (EP). Data on all births during 1980-1982 show no significant difference in pregnancy outcomes between women receiving free prenatal care from the government and women receiving private care from obstetricians.

PIP: This paper reports the results of a prenatal care program in Martinique aimed at preventing preterm deliveries among women of low socioeconomic status. It was based on the assumption that high-quality preventive care during pregnancy can substantially improve pregnancy outcomes among disadvantaged women. During 1976-78, the government's maternal and child health department (PMI) took steps to ensure easy access to prenatal care for all women in Martinique. New service sites were established, existing sites were improved, and health personnel were given special training on the recognition of high-risk pregnancies. The mean number of prenatal visits/woman to government clinics increased from 4.9 in 1978 to 6.2 in 1982. During this period, the percentage of women attending a free clinic in the 1st trimester of pregnancy rose from 39% to 64%. In 1981, 42% of all births were to women who received prenatal care through the PMI and delivered in public facilities. 22% were to women who received prenatal care and delivered within the private health care system, and the remaining 36% were to women to delivered in public facilities but did not received prenatal care through the PMI system. To evaluate the impact of the government prenatal care program, the outcomes of all births in Martinique in 1980, 1981, and 1982 were compared by type of prenatal care. Although women who received private prenatal care belonged to a higher socioeconomic class, there were no significant differences between women receiving private or public prenatal care in terms of preterm deliveries, low birthweight, or perinatal mortality. This finding suggests that the social class effect on pregnancy outcome can be eliminated through preventive prenatal care. It is further noted that the Martinique program did not involve an emphasis on expensive equipment or the services of specialists; rather, patient education and upgrading the skills of midwwives were central features.

PMID: 6151916 [PubMed - indexed for MEDLINE]