Maternal health and contraception

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definitions

• maternal death
  • death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes
• maternal mortality ratio (MMR)
  • =[math]\displaystyle{ \frac{Number\ of\ maternal\ deaths}{Number\ of\ live\ births} }[/math]
  • denominator is not number of pregnant women because pregnancy could be easily missed, or counting new babies is easy to investigate under context of LMICs
  • established death statistics is necessary to calculate precise MMR, but still it is difficult to distinguish whether each pregnant woman's death is maternal death or by other cause
  • MMR is not sensitive indicator of maternal health

how to accurately estimate maternal mortality

• regression modeling methods
  • United Nations Maternal Mortality Estimation Inter-agency Group (MMEIG)
  • Global Burden of Disease (GBD) research

Family Planning - A global handbook for providers 2018 edition

terminology

• words "family planning" and "contraception" are virtually interchangeable
• no definition so far

history

• Malthusiasm
  • Thomas Malthus
  • Malthusian catastrophe
    • improvement of food production surges exponential increase of population
• International Conference on Population and Development (ICPD), Cairo, 1994
  • transition from contraception for population control to women's rights-based family planning
• London Summit on Family Planning, London, 2012

influence of family planning on individual health

• contraception effects of childbearing pattern as well as on a woman herself
  • survival and health
  • nutrition
  • emotional support, parental care
  • education
  • physical and

• more parities higher mortality except for the first child
• longer interpregnancy interval higher risks for adverse perinatal outcome
  • reason hypothesis: nutritional depletion, folate?
  • best >20 months <60 months

effect of family planning	mother	child
parity, birth order and unwanted pregnancy	++++	+
age at first birth	+	+++
high maternal age	+++	+
interpregnancy interval	+	+++