Making Motherhood Safe (World Bank, 1993, 161 pages)

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Abstract

Foreword

Acknowledgements

Abbreviations

Executive summary

Chapter 1 - Maternal morbidity and mortality and the consequences

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Complications of pregnancy and their consequences

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Effects on the mother

Effects on the fetus or newborn

Effects on the household and community

Barriers to maternal health care

Lessons learned

Chapter 2 - Essential elements of a safe motherhood program

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Factors influencing safe motherhood

Components of a safe motherhood program

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Community-based care

Facility-based care and referral

Information, education, and communications

Summary

Chapter 3 - A strategy for safe motherhood in representative settings

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Three examples of programs designed for local conditions

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Setting A: Expanding family planning and deliveries attended by trained providers - Initial safe motherhood activities where resources are scarce

Setting B: Upgrading provider skills and strengthening the referral system - Emphasizing the use of improved services

Setting C: Maximizing women's access to and efficient use of reproductive health services

Critical issues for all developing countries

Chapter 4 - Policy and planning considerations

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Building commitment

Planning safe motherhood programs

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Needs assessment

Adapting existing health systems to meet women's needs

Strengthening the health infrastructure

Upgrading health facilities

Upgrading the skills of health providers and delegating responsibility

Strengthening intra- and inter-sectoral coordination

Alarm and transport systems

Women's health and status

Maximizing resources

Influencing policy and practice

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Information, education, and communications

Regulation and legislation

Subsidies, user fees, and insurance

The role of the world bank and other international agencies

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Principles of bank involvement

Bank operations

Donor financing and coordination

Chapter 5 - The costs of safe motherhood

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Cost implications for the three settings

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Existing resources

The interventions

Cost-estimating methodology

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Existing costs

Intervention costs

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Total costs

Findings

Next steps

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Data collection and research

Financing options

Chapter 6 - Measuring progress

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Information needs for safe motherhood

Measurement techniques and sources of data

Selection and use of indicators

Examples of impact indicators

Maternal mortality

Perinatal mortality

Examples of process indicators

Obstetric complications

Other service indicators

Possible indicators for assessing progress in safe motherhood programs

Appendix 1 - Effective maternal health care: Family planning and prenatal, labor, delivery, and postpartum care

Appendix 2 - Country examples of safe motherhood programs

Appendix 3 - The role of the midwife

Appendix 4 - Maternity center facilities and equipment

Appendix 5 - Behavior change: The role of information, education, and communications in safe motherhood programs

Appendix 6 - Maternal and perinatal health assessment

Appendix 7 - Issues related to maternal anthropometry

Appendix 8 - Technical notes and tables

Bibliography

Distributors of world bank publications