the authors compared the efficacy and safety of detoxification from opioids compared with opioid replacement therapy (ORT) during pregnancy. indings suggest an increased risk of relapse with detoxification treatment compared with ORT; however, detoxification does not alter the risk of preterm birth or neonatal abstinece syndrome. Further studies should confirm our findings and explore mechanisms to fight the current opioid epidemic.
How much do conditional cash transfers increase the utilization of maternal and child health care services? New evidence from Janani Suraksha Yojana in India.by Rahman MM et al
Janani Suraksha Yojana (safe motherhood scheme, or JSY) provides cash incentives to marginal pregnant women in India conditional on having mainly institutional delivery. Using the fourth round of district level household survey (DLHS-4), we have estimated its effects on both intended and unintended outcomes. Our estimates of average treatment effect on the treated (ATT) from propensity score matching are remarkably higher than those found in previous prominent studies using the second and third rounds of the survey (DLHS-2 and DLHS-3). When we apply fuzzy regression discontinuity design exploiting the second birth order, our estimates of local average treatment effect (LATE) are much higher than that of ATT. For example, due to JSY, institutional delivery increases by around 16 percentage points according to ATT estimate but about 23 percentage points according to LATE estimate.
In 2015, 2·6 million stillbirths were estimated globally, more than 7100 deaths a day, with most occurring in developing countries. These figures are substantial, yet they are an underestimation of the full extent of this loss because stillbirths at less than 28 weeks of pregnancy are not included in these numbers. If the 22-week threshold was applied, the numbers have been estimated to be 40% higher.
Global Abortion Policies Database: a new approach to strengthening knowledge on laws, policies, and human rights standardsby Ronald Johnson Jr et al
The GAPD is a comprehensive tool that can be used to strengthen knowledge, inform law and policy research to generate evidence on the impact of laws and policies in practice, and facilitate greater awareness of the many challenges to creating enabling policy environments for safe abortion.
Trends in adolescent first births in five countries in Latin America and the Caribbean: disaggregated data from demographic and health surveysby Neal et al
The study draws on Demographic and Health Survey data from five countries where three surveys are available since 1990, with the most recent after 2006. It examines trends in adolescent births by wealth status and urban/rural residence. The study draws on Demographic and Health Survey data from five countries where three surveys are available since 1990, with the most recent after 2006. It examines trends in adolescent births by wealth status and urban/rural residence.
The World Health Organization has developed a multistep approach to health inequality monitoring consisting of: (i) determining the scope of monitoring; (ii) obtaining data; (iii) analysing data; (iv) reporting results; and (v) implementing changes. This paper presents some technical considerations for developing or strengthening health inequality monitoring, with the aim of encouraging more robust, systematic and transparent practices. It discusses key aspects of measuring health inequalities that are relevant to steps (i) and (iii).
The authors analyzed state-level maternal mortality for the years 1997–2012 using multilevel mixed-effects regression grouped by state, using publicly available data including whether a state had adopted the 2003 U.S. Standard Certificate of Death, designed to simplify identification of pregnant and recently pregnant decedents. Findings indicate that, in addition to better case ascertainment of maternal deaths, adverse changes in chronic diseases, insufficient healthcare access, and social determinants of health represent identifiable risks for maternal mortality that merit prompt attention in population-directed interventions and health policies.
Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016by GBD 2016 Brazil Collaborators published in The Lancet
Clinicians’ views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studiesby Panda et al
This systematic review aimed to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report obstetricians’ and midwives’ views on the factors that influence the decision to perform caesarean section. This systematic review and metasynthesis identified clinicians’ personal beliefs as a major factor that influenced the decision to perform caesarean section, further contributed by the influence of factors related to the health care system and clinicians’ characteristics. Obstetricians and midwives are directly involved in the decision to perform a caesarean section, hence their perspectives are vital in understanding various factors that have influence on decision-making for caesarean section. These results can help clinicians identify and acknowledge their role as crucial members in the decision-making process for caesarean section within their organisation, and to develop intervention studies to reduce caesarean section rates in future.
The magnitude and severity of abortion-related morbidity in settings with limited access to abortion services: a systematic review and meta-regressionby Calvert et al
This systematic review aims to estimate the magnitude and severity of complications associated with abortion in areas where access to abortion is limited, with a particular focus on potentially life-threatening complications. In spite of the challenges on how near miss morbidity has been defined and measured in the included studies, our results suggest that a substantial percentage of abortion-related hospital admissions have potentially life-threatening complications. Estimates that are more reliable will only be obtained with increased use of standard definitions such as the WHO near-miss criteria and/or better reporting of clinical criteria applied in studies.
Impact of integrating a postpartum family planning program into a community-based maternal and newborn health program on birth spacing and preterm birth in rural Bangladeshby Baqui et al
In a quasi-experimental trial design, unions with an average population of about 25 000 and a first level health facility were allocated to an intervention arm (n = 4) to receive integrated post-partum family planning and maternal and newborn health (PPFP-MNH) interventions, or to a control arm (n = 4) to receive the MNH interventions only. Study findings demonstrate the feasibility and effectiveness of integrating PPFP interventions into a community based MNH intervention package. Thus, MNH programs should consider systematically integrating PPFP as a service component to improve pregnancy spacing and reduce the risk of preterm birth.
The aim of this study was to determine whether an intervention designed to involve the male partners of pregnant women in Burkina Faso in facility-based maternity care influences care-seeking and healthy practices after childbirth. The hypothesis was that the intervention would increase postnatal care attendance, the duration of exclusive breastfeeding and the use of postpartum contraception. Findings suggest that the intervention to involve male partners in maternity care was associated with an increase in attendance at postnatal care consultations, in the duration of exclusive breastfeeding and in the use of postpartum contraception, especially long-acting, reversible contraception. The intervention also had a positive effect on communication between the couple and shared decision-making related to reproductive health.
This large trial compared a novel formulation of heat-stable carbetocin with oxytocin. The study enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Findings suggest that heat-stable carbetocin was noninferior to oxytocin for the prevention of blood loss of at least 500 ml or the use of additional uterotonic agents. Noninferiority was not shown for the outcome of blood loss of at least 1000 ml; low event rates for this outcome reduced the power of the trial.
The objective was to determine whether low dose aspirin reduces the rate of spontaneous PTB in nulliparous women without medical co-morbidities. This is a secondary analysis of a randomized, placebo-controlled trial of low dose aspirin for prevention of preeclampsia in healthy, low-risk, nulliparous women. Low dose aspirin is associated with a substantial decrease in spontaneous PTB <34wks in healthy nulliparous women without co-morbidities. These findings suggest a new therapeutic option for PTB prevention that requires further study.
Improvement in the active management of the third stage of labor for the prevention of postpartum hemorrhage in Tanzania: a cross-sectional studyby Bishanga et al
A cross-sectional study was conducted in 52 health facilities in Tanzania utilizing direct observations of women during labor and delivery. Findings suggets that the quality of PPH prevention increased substantially in facilities that implemented competency-based training and quality improvement interventions, with the most dramatic improvement seen at lower-level facilities. As Tanzania continues with efforts to increase facility births, it is imperative that the quality of care also be improved by promoting use of up-to-date guidelines and ensuring regular training and mentoring for health care providers so that they adhere to the guidelines for care of women during labor. These measures can reduce maternal and newborn mortality.
National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysisby Lange et al
Smoking during pregnancy has been linked to numerous adverse health consequences for both the developing fetus and mother. This study estimated the prevalence of smoking during pregnancy by country, WHO region, and globally and the proportion of pregnant women who smoked during pregnancy, by frequency and quantity, on a global level. The findings suggest that smoking during pregnancy is still a prevalent behaviour in many countries. These findings should inform smoking prevention programmes and health promotion strategies, as well as draw attention to the need for improved access to smoking cessation programmes for pregnant women.
Burden of physical, psychological and social ill-health during and after pregnancy among women in India, Pakistan, Kenya and Malawiby McCauley et al
For every woman who dies during pregnancy and childbirth, many more suffer ill-health, the burden of which is highest in low-resource settings. The study sought to assess the extent and types of maternal morbidity. Findings from this study suggests that women suffer significant ill-health which is still largely unrecognised. Current antenatal and postnatal care packages require adaptation if they are to meet the identified health needs of women.