|03. What Is the Evidence for the Role of Antenatal Care Strategies in the Reduction of Maternal Mortality and Morbidity?|
It should be emphasized that there is very little factual evidence that antenatal care does reduce maternal mortality. In this brief survey of if and how antenatal care reduces maternal mortality we have left several important points untouched. The organization and distribution of maternal health services and its providers, the role of non-governmental organisations (NGOs), abortion laws and practices, and levels of education among women are relevant factors which should be clarified and evaluated within each third world country. Governments should clarify gaps between central policies and actually delivered health care, and intensify their efforts to improve the quality of services. Maternal health is an integral part of reproductive health and should not be viewed in isolation; the problem is also linked to HIV and its consequences.
In a critical review (McDonagh 1996) emphasized that to have any effect antenatal care must be part of a system of care that culminates in good local obstetric facilities with adequately trained staff. It is easy to agree.
To finally quote (Rooney 1992), basic research both epidemiological and operational, on antenatal care is not an academic luxury; improved information on patterns of maternal health and the efficacy of investigation and treatment are essential to rational planning of effective health services to reduce maternal mortality and morbidity from their current alarming levels.
However, on the assumption that history occasionally repeats itself, the evolution of maternal mortality in the developed countries during the 20th century gives at least a guarded cause for optimism.