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Female genital mutilation (FGM) management during pregnancy, childbirth and the postpartum period

International Journal of Gynecology & Obstetrics. 2000 july:70(1)99-104

Female genital mutilation (FGM) management during pregnancy, childbirth and the postpartum period

Rushwan H

Abstract 

Female genital mutilation (FGM) is a traditional practice with serious health consequences to women that is still practiced in 28 countries with approximately 2 million girls exposed to the practice annually. The complications of FGM cause suffering to the woman all her life. Pregnancy, childbirth and the postpartum period are particularly important as there is increased risk of mortality and morbidity from FGM complications. Although the overall strategy should be to eliminate the practice completely, the healthcare providers and policy makers in the meantime should not only be aware but also well trained in the management of FGM complications to decrease the risk of mortality and serious morbidity.

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Original research

Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care.

Reprod Health. 2005 May 4;2(1):3.

Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care.

Cham M, Sundby J, Vangen S.

Institute of Community Medicine, Faculty of Medicine, University of Oslo, Norway. johanne.sundby@medisin.uio.no.

Abstract

BACKGROUND: Maternal mortality is the vital indicator with the greatest disparity between developed and developing countries. The challenging nature of measuring maternal mortality has made it necessary to perform an action-oriented means of gathering information on where, how and why deaths are occurring; what kinds of action are needed and have been taken. A maternal death review is an in-depth investigation of the causes and circumstances surrounding maternal deaths. The objectives of the present study were to describe the socio-cultural and health service factors associated with maternal deaths in rural Gambia.

METHODS: We reviewed the cases of 42 maternal deaths of women who actually tried to reach or have reached health care services. A verbal autopsy technique was applied for 32 of the cases. Key people who had witnessed any stage during the process leading to death were interviewed. Health care staff who participated in the provision of care to the deceased was also interviewed. All interviews were tape recorded and analyzed by using a grounded theory approach. The standard WHO definition of maternal deaths was used.

RESULTS: The length of time in delay within each phase of the model was estimated from the moment the woman, her family or health care providers realized that there was a complication until the decision to seeking or implementing care was made. The following items evolved as important: underestimation of the severity of the complication, bad experience with the health care system, delay in reaching an appropriate medical facility, lack of transportation, prolonged transportation, seeking care at more than one medical facility and delay in receiving prompt and appropriate care after reaching the hospital.

CONCLUSION: Women do seek access to care for obstetric emergencies, but because of a variety of problems encountered, appropriate care is often delayed. Disorganized health care with lack of prompt response to emergencies is a major factor contributing to a continued high mortality rate.

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Assessing the burden of sexual and reproductive ill-health: questions regarding the use of disability-adjusted life years

Bull World Health Organ 2000 78(5)

Assessing the burden of sexual and reproductive ill-health: questions regarding the use of disability-adjusted life years

C. AbouZahrI; J.P. VaughanII

IFormerly Technical Officer, Department of Reproductive Health and Research, World Health Organization, Geneva 
IIProfessor of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, England

ABSTRACT

The use of the disability-adjusted life year (DALY) as the unit in which to calculate the burden of disease associated with reproductive ill-health has given rise to considerable debate. Criticisms include the failure to address the problem of missing and inadequate epidemiological data, inability to deal adequately with co-morbidities, and lack of transparency in the process of ascribing disability weights to sexual and reproductive health conditions. Many of these criticisms could be addressed within the current DALY framework and a number of suggestions to do so are made. These suggestions include: (1) developing an international research strategy to determine the incidence and prevalence of reproductive ill-health and diseases, including the risk of long-term complications; (2) undertaking a research strategy using case studies, population-based surveillance data and longitudinal studies to identify, evaluate and utilize more of the existing national data sources on sexual and reproductive health; (3) comprehensively mapping the natural history of sexual and reproductive health conditions — in males and in females — and their sequelae, whether physical or psychological; (4) developing valuation instruments that are adaptable for both chronic and acute health states, that reflect a range of severity for each health state and can be modified to reflect prognosis; (5) undertaking a full review of the DALY methodology to determine what changes may be made to reduce sources of methodological and gender bias. Despite the many criticisms of the DALY as a measurement unit, it represents a major conceptual advance since it permits the combination of life expectancy and levels of dysfunction into a single measure. Measuring reproductive ill-health by counting deaths alone is inadequate for a proper understanding of the dimensions of the problem because of the young age of many of the deaths associated with reproductive ill-health and the large component of years lived with disability from many of the associated conditions.

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