Explores the many complex factors responsible for the huge number of preventable maternal deaths that continue to occur each year. Utilizing more than 400 references to the literature, the book documents the range of problems from personal fatalism, through social customs, to the shortcomings of the health services that must be understood if the special and long-neglected health needs of women are to receive appropriate attention. The book opens with a discussion of methodological problems in data collection and reporting that help explain why most official maternal mortality rates are underestimates. The second chapter illustrates the dimensions of the problem through a review of available data on death rates and risks associated with childbearing in Africa, Asia, Latin America, and the developed countries. Numerous case histories and examples from field research are then used to explore the various social, cultural, and political factors which together determine the status of women, their health, fertility, and health-seeking behaviour. Factors discussed range from son preference and rules of inheritance to the link between women's perceptions of the health services and the reasons why these services so often fail to meet their needs. Having characterized the dimensions of the problem, the book turns to questions of causes and prevention. Readers are first introduced to the main diseases and complications of pregnancy, their chief cause, the types of women most likely to be affected, and relevant preventive actions. Deaths due to abortion are considered in the next chapter, which examines the social context of abortion, discusses its legal status, and documents health consequences in different parts of the world. The costs to the health services of dealing with the complications of illegal abortions are also critically assessed. Other chapters concentrate on the complications, sometimes life-long, of pregnancy and labour, the logistic causes of maternal death as these relate to weaknesses and failures in the health services, and the specific changes in health care and family planning services needed to prevent maternal deaths. The book concludes with a call to action, underscoring the capacity of simple, inexpensive preventive measures to have a major impact on the death and suffering so long condoned as part of motherhood.

eng fre spa.

ind.

WHODOC

WHO monograph

4