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World Health Stat Q. 1995;48(1):4-7.

Argentina: risk factors and maternal mortality in La Matanza, Province of Buenos Aires, 1990.

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  • 1Grupo de Investigación y Difusión de la Atención Primaria de la Salud, Buenos Aires, Argentina.

Abstract

An evaluation of the health services infrastructure of the La Matanza part of Buenos Aires in 1990 was carried out in addition to an evaluation of maternal mortality case studies. This procedure allowed for an assessment of factors related to the performance of health services and the health behaviour of women which, concomitantly, led to maternal deaths. Approximately 50% of maternal deaths went unreported in La Matanza on the basis of record checks performed in the institutions, hence the maternal mortality was twice as high as officially indicated for 1990. Flaws in the proper clinical diagnosis of the causes of deaths were detected and a higher degree of precision was called for. In the case of women who came from the poorest section of La Matanza, most deaths were due to complications related to abortion (either self-induced or non-professionally induced). Most of the maternal deaths could have been avoided. The sociological enquiry revealed conflicting social pressures which led the women onto the path of maternal death. The men were found not to be involved in the health issues arising from pregnancy and delivery, and the reproductive process was seen to lie exclusively in the women's domain. The services were not prepared to cater for the needs of poor women, and the inadequacy of the existing system to reach the women in need was well documented. Detection of women at risk was lacking in most establishments and, with the exception of one hospital, referral procedures did not exist. At the municipal level the absence of a policy for maternal and child health was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP:

This article summarizes the results of an evaluation of health services infrastructure and maternal mortality in the La Matanza part of Buenos Aires in 1990. About 50% of maternal mortality was unreported. Clinical diagnosis of causes of deaths were flawed. Many of the low-income women suffered from abortion-related complications. The health system was not prepared to deal with the needs of poor women and did not reach out to women in need. Screening for women at risk was lacking in most health facilities, and referral procedures did not exist for all but one facility. Municipal government did not have a policy on maternal and child health. Recommendations are to establish program goals for maternal health, to abolish barriers to use of prenatal care, to train obstetricians in continuous risk management and in meeting the special needs of poor women, and to establish interdisciplinary teams for reaching poor women in need. Suggestions are to personalize approaches, improve the referral system, and improve primary health care. The study population comprised 9% of the total Buenos Aires provincial population and 3.5% of Argentina's total population. 41.5% of the study population were women 10-54 years old. Service provision had not kept pace with population growth. Demand for obstetric hospital beds exceeded the available supply. Four private hospitals are inadequately equipped for maternal care. The data collection process uncovered 29 female deaths, of which 21 were confirmed as maternal deaths and about 10 were unregistered as maternal deaths. All deaths were to women who lived in the poorer sections. Almost 50% of family members disagreed with the physician-designated cause of death, and about 40% thought that the deaths were preventable. Almost 25% of family members considered pregnancy services "good." 1167 cesarean sections were recorded in 1990, of which 32% were performed in private facilities. 26% of all private sector deliveries (a high figure) were by cesarean section. The ratio of professionals (for example, obstetricians) to maternity patients was 1:2,106 women of childbearing age. 81% of admissions to municipal and private hospitals were related to abortions. 4625 newborns were registered for 7644 deliveries, or under-registration of 39%.

PMID:
7571710
[PubMed - indexed for MEDLINE]
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