Suchergebnisse

Every year about half a million women die from complications of pregnancy, parturition and puerperium, most of which are preventable. The purpose of this thesis was to chart the distribution and decline in maternal mortality in Sweden between 1751 and 1980, and furthermore to characterize positive (predisposing) factors and negative (protective) factors of maternal mortality. Maternal mortality declined from 900 to 6.6 per 100,000 live births in these 230 years. Maternal deaths accounted for 10070 of all female deaths in the reproductive ages between 1781 and 1785, but only 0.2.0/0 between 1976 and 1980. However, in the 19th century 40-450/0 of the female deaths in the most active childbearing ages were maternal deaths. The children left motherless had an extremely high mortality. Indirect maternal deaths and puerperal sepsis accounted for the bulk of maternal deaths in the rural areas. Only a minority of maternal deaths occurred in lying-in hospitals. Midwifery services in rural areas and antiseptic techniques were most effective in preventing maternal deaths during the late 19th century. The changing distribution ofage and parity amongst the parturients had a definite impact on the mortality decline, enhanced by time, contributing to 500/0 of the mortality decline over the last 15 years. The expontential decline of cause-specific mortality and case fatality rates during the last 40 years is furthermore explained by the emergence ofmodern medicine - antibiotics, antenatal and obstetric care. The earlier serious problem of illegal abortions was eradicated by legislation and changes in hospital practice. The maternal mortality decline has levelled out during the 1970s, the relative importance of embolism as a cause of death is increasing. Advanced age and intercurrent disease are the most difficult risk factors to overcome. To conclude, this study indicates that the reason why maternal mortality has declined faster than otherhealth indices is that the major part of the maternal deaths can be prevented by medical technology, including family planning, antenatal and obstetric care. This experience should be of interest to developing countries where high rates of maternal mortality prevails.

Sara Ruddick's Maternal Thinking represents a great contribution to moral philosophy—in particular, by bringing women's "private" virtues into the public sphere. However, there remain problems in the analysis which need to be addressed: How can one possibly generalize about the practice of mothering from one, necessarily limited, perspective, given the facts of cultural diversity? Is Ruddick's normative account of mothering congruent with the reflective judgments of others? Is her account of the transformation of parochial mothering into feminist peace work viable? After exploring these three questions, this reviewer calk, with Ruddkk, for the telling of more maternal stories, from different cultural, racial and economic perspectives.

AbstractIn order to investigate a possible association between maternal smoking during pregnancy and twinning, information on 1 096 330 single births and 12 342 twin births in 1983–95 was obtained from the Swedish Medical Birth Registry (MBR). All odds ratios (OR) were estimated after stratification for year of birth and maternal age, parity, and educational level. Smoking women, compared with non-smoking women, were at increased risk of having dizygotic (DZ) twins, but the risk increase was only evident among multiparas. A strong association between previous involuntary childlessness and dizygotic (DZ) twinning (especially in primiparas) was found. The strongest association between maternal smoking and DZ twinning was found among multiparas without any history of involuntary childlessness (OR: 1.35, 95%CI:1.22–1.49), whereas among women who had experienced involuntary childlessness, the opposite was seen (OR: 0.82, 95%CI:0.66–1.00, no difference between parity strata). Weinberg's differential method was used to estimate the number of monozygotic (MZ) twins, and a method of estimating stratified ORs among mothers of MZ twins was presented. No association was found between MZ twinning and maternal smoking (OR: 0.96, 95%CI:0.86–1.07), and no confounding by parity or previous involuntary childlessness was indicated. Several non-causal explanations to the positive association between DZ twinning and maternal smoking among multiparas were discussed, but homogeneity over strata indicated that maternal smoking may be a true risk factor for double ovulation.

This study presents estimates of maternal mortality for India from two indirect procedures, the sisterhood method and a regression method involving sex differentials in adult mortality, and compares them with estimates available from other sources. The sisterhood method is applied to the data collected in a human development survey that covered all rural areas of India in 1994, while the latter method is applied to the data on mortality and fertility rates from India's Sample Registration System. The level of maternal mortality for the early 1980s implied by the sisterhood method is found to be about 15 percent lower than the estimate for the same period derived from the method that uses the data on sex differentials in adult mortality. The estimate for the 1990s from the latter method is consistent, however, with the direct estimates available from the National Family Health Survey and the Sample Registration System. The study also discusses the socioeconomic differentials in maternal mortality implied by the sisterhood data, and spatial and temporal variations in maternal mortality derived from the regression method.