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Blanc A.K.,Population Council | Winfrey W.,FutuResearch Institute | Ross J.,FutuResearch Group
PLoS ONE | Year: 2013

Background:With recent results showing a global decline in overall maternal mortality during the last two decades and with the target date for achieving the Millennium Development Goals only four years away, the question of how to continue or even accelerate the decline has become more pressing. By knowing where the risk is highest as well as where the numbers of deaths are greatest, it may be possible to re-direct resources and fine-tune strategies for greater effectiveness in efforts to reduce maternal mortality.Methods:We aggregate data from 38 Demographic and Health Surveys that included a maternal mortality module and were conducted in 2000 or later to produce maternal mortality ratios, rates, and numbers of deaths by five year age groups, separately by residence, region, and overall mortality level.Findings:The age pattern of maternal mortality is broadly similar across regions, type of place of residence, and overall level of maternal mortality. A "J" shaped curve, with markedly higher risk after age 30, is evident in all groups. We find that the excess risk among adolescents is of a much lower magnitude than is generally assumed. The oldest age groups appear to be especially resistant to change. We also find evidence of extremely elevated risk among older mothers in countries with high levels of HIV prevalence.Conclusions:The largest number of deaths occurs in the age groups from 20-34, largely because those are the ages at which women are most likely to give birth so efforts directed at this group would most effectively reduce the number of deaths. Yet equity considerations suggest that efforts also be directed toward those most at risk, i.e., older women and adolescents. Because women are at risk each time they become pregnant, fulfilling the substantial unmet need for contraception is a cross-cutting strategy that can address both effectiveness and equity concerns. © 2013 Blanc et al.

Hardee K.,FutuResearch Group | Gay J.,J. Gay Consultants LLC | Croce-Galis M.,Artemis | Peltz A.,United States Agency for International Development
Journal of the International AIDS Society | Year: 2014

There is growing interest in expanding public health approaches that address social and structural drivers that affect the environment in which behaviour occurs. Half of those living with HIV infection are women. The sociocultural and political environment in which women live can enable or inhibit their ability to protect themselves from acquiring HIV. This paper examines the evidence related to six key social and structural drivers of HIV for women: transforming gender norms; addressing violence against women; transforming legal norms to empower women; promoting women's employment, income and livelihood opportunities; advancing education for girls and reducing stigma and discrimination. The paper reviews the evidence for successful and promising social and structural interventions related to each driver. This analysis contains peer-reviewed published research and study reports with clear and transparent data on the effectiveness of interventions. Structural interventions to address these key social and structural drivers have led to increasing HIV-protective behaviours, creating more gender-equitable relationships and decreasing violence, improving services for women, increasing widows' ability to cope with HIV and reducing behaviour that increases HIV risk, particularly among young people. © 2014 Hardee K et al; licensee International AIDS Society.

Unintended pregnancies can lead to poor maternal and child health outcomes. Family planning use during the first year postpartum has the potential to significantly reduce at least some of these unintended pregnancies. This paper examines the relationship of menses return, breastfeeding status, and postpartum duration on return to sexual activity and use of modern family planning among postpartum women. This paper presents results from a secondary data analysis of Demographic and Health Surveys from 17 countries. For postpartum women, the return of menses, breastfeeding status, and postpartum duration are significantly associated with return to sexual activity in at least 10 out of the 17 countries but not consistently associated with family planning use. Only menses return had a significant association with use of modern family planning in the majority of countries. These findings point to the importance of education about pregnancy risk prior to menses return.

Ross J.A.,FutuResearch Group | Blanc A.K.,Maternal Health Task Force
Maternal and Child Health Journal | Year: 2012

Globally, the number of maternal deaths remains large, and the risk per birth is high in the developing world. Deaths declined between 1990 and 2008, despite the 42% increase in women. We decompose selected determinants to help explain the decline. Numbers of women, births, and fertility rates come from the UN; maternal mortality ratios are from the UN and from Hogan et al. Decomposition isolates the effects of additional women, decreases in fertility, and declines in mortality ratios, also in rates. Women aged 15-49 increased by 42%, but births remained constant due to declining fertility rates. The fertility decline alone averted approximately 1.7 million deaths, 1990-2008. The risk per birth (MMR) also fell, adding to the decline in the number of deaths. Exceptional declines occurred in the maternal mortality rate. Sub- Saharan Africa has experienced minimal declines in deaths, due to increases in women and small declines in fertility and mortality. The growing numbers of women have made international efforts to reduce the number of maternal deaths ever more challenging. Comparatively little attention has been given to the offsetting effect of the historic fertility declines in the developing world, and hence a flat trend in births. The maternal mortality ratio has also fallen, reflecting the success of direct maternal health efforts. Programs that provide couples with the means to control their fertility can reinforce fertility declines. These programs are companions to ongoing, direct measures to reduce the risk of death once pregnant. © Springer Science+Business Media, LLC 2011.

Nutley T.,FutuResearch Group | Reynolds H.W.,University of North Carolina at Chapel Hill
Global Health Action | Year: 2013

Background: Good quality and timely data from health information systems are the foundation of all health systems. However, too often data sit in reports, on shelves or in databases and are not sufficiently utilised in policy and program development, improvement, strategic planning and advocacy. Without specific interventions aimed at improving the use of data produced by information systems, health systems will never fully be able to meet the needs of the populations they serve. Objective: To employ a logic model to describe a pathway of how specific activities and interventions can strengthen the use of health data in decision making to ultimately strengthen the health system. Design: A logic model was developed to provide a practical strategy for developing, monitoring and evaluating interventions to strengthen the use of data in decision making. The model draws on the collective strengths and similarities of previous work and adds to those previous works by making specific recommendations about interventions and activities that are most proximate to affect the use of data in decision making. The model provides an organizing framework for how interventions and activities work to strengthen the systematic demand, synthesis, review, and use of data. Results: The logic model and guidance are presented to facilitate its widespread use and to enable improved data-informed decision making in program review and planning, advocacy, policy development. Real world examples from the literature support the feasible application of the activities outlined in the model. Conclusions: The logic model provides specific and comprehensive guidance to improve data demand and use. It can be used to design, monitor and evaluate interventions, and to improve demand for, and use of, data in decision making. As more interventions are implemented to improve use of health data, those efforts need to be evaluated. © 2013 Tara Nutley and HeidiW. Reynolds.

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