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Issues related to maternal mortality have generated a lot of empirical and theoretical information. However, despite the amount of work published on the topic, maternal mortality continues to occur at high rates and solutions to the problem are still not clear. Scientific research on maternal mortality is focused mainly on clinical factors. However, this approach may not be the most useful if we are to understand the problem of maternal mortality as a whole and appreciate the importance of economical, political and social macrostructural factors. In this paper, we report the number of scientific studies published between 2000 and 2004 about the main causes of maternal death, as identified by WHO, and compare the proportion of papers on each cause with the corresponding burden of each cause. Secondly, we systematically review the characteristics and quality of the papers on the macrostructural determinants of maternal mortality. In view of their burden, obstructed labour, unsafe abortion and haemorrhage are proportionally underrepresented in the scientific literature. In our review, most studies analysed were cross-sectional, and were carried out by developed countries without the participation of researchers in the developing countries where maternal mortality was studied. The main macrostructural factors mentioned were socioeconomic variables. Overall, there is a lack of published information about the cultural and political determinants of maternal mortality. We believe that a high-quality scientific approach must be taken in studies of maternal mortality in order to obtain robust comparative data and that study design should be improved to allow causality between macrostructural determinants and maternal mortality to be shown.

Issues related to maternal mortality have generated a lot of empirical and theoretical information. However, despite the amount of work published on the topic, maternal mortality continues to occur at high rates and solutions to the problem are still not clear. Scientific research on maternal mortality is focused mainly on clinical factors. However, this approach may not be the most useful if we are to understand the problem of maternal mortality as a whole and appreciate the importance of economical, political and social macrostructural factors. In this paper, we report the number of scientific studies published between 2000 and 2004 about the main causes of maternal death, as identified by WHO, and compare the proportion of papers on each cause with the corresponding burden of each cause. Secondly, we systematically review the characteristics and quality of the papers on the macrostructural determinants of maternal mortality. In view of their burden, obstructed labour, unsafe abortion and haemorrhage are proportionally underrepresented in the scientific literature. In our review, most studies analysed were cross-sectional, and were carried out by developed countries without the participation of researchers in the developing countries where maternal mortality was studied. The main macrostructural factors mentioned were socioeconomic variables. Overall, there is a lack of published information about the cultural and political determinants of maternal mortality. We believe that a high-quality scientific approach must be taken in studies of maternal mortality in order to obtain robust comparative data and that study design should be improved to allow causality between macrostructural determinants and maternal mortality to be shown. ; Los temas relacionados con la mortalidad materna han generado abundante información empírica y teórica. Sin embargo, pese a los muchos trabajos publicados sobre el tema, las tasas de mortalidad materna siguen siendo altas, y las soluciones a este problema siguen también sin estar claras. Las investigaciones científicas sobre la mortalidad materna se centran principalmente en los factores clínicos. Sin embargo, puede que este enfoque no sea el más conveniente para lograr comprender el problema de la mortalidad materna en su globalidad y apreciar la importancia de los factores macroestructurales de índole económica, política y social. En este artículo analizamos el número de estudios científicos publicados entre 2000 y 2004 sobre las causas principales de mortalidad materna según la OMS, comparando la proporción de artículos sobre cada causa con la carga correspondiente a la misma. En segundo lugar, examinamos sistemáticamente las características y la calidad de los artículos sobre los determinantes macroestructurales de la mortalidad materna. A la vista de la carga que representan, el parto obstruido, el aborto peligroso y la hemorragia están subrepresentados proporcionalmente en la bibliografía científica. En nuestra revisión, la mayoría de los estudios analizados eran transversales, y habían sido realizados por países desarrollados sin la participación de investigadores de los países en desarrollo donde se estudió la mortalidad materna. Los principales factores macroestructurales mencionados eran variables socioeconómicas. En términos generales, se observa una escasez de publicaciones sobre los determinantes culturales y políticos de la mortalidad materna. Consideramos que los estudios sobre ésta deben adoptar un enfoque científico de calidad que permita obtener datos robustos y comparables, y que el diseño de esos estudios debe mejorarse para poner de manifiesto las relaciones de causalidad entre los determinantes macroestructurales y la mortalidad materna.

Objetivos: Describir sistemáticamente las características de los procesos de formulación y toma de decisiones vinculadas al poder legislativo del Estado español en materia de violencia de género. Métodos: Búsqueda y análisis de contenido cuantitativo de todas las iniciativas parlamentarias del Congreso de los Diputados y del Senado sobre violencia de género (1979-2004). Se calculó la razón entre las iniciativas de violencia de género y las iniciativas de otros temas por años y legislaturas. Se analizó la probabilidad de presentar iniciativas sobre violencia de género por sexo y según pertenencia al gobierno u oposición (odds ratio [OR], intervalo de confianza [IC] del 95% y significación estadística [método Mantel-Haenszel]). Resultados: En 26 años se produjeron 322.187 iniciativas parlamentarias, de las que 569 fueron sobre violencia de género. Destacan las tasas de iniciativas de 1998 (4,12 por 1.000), 2001 (4,49 por 1.000) y 2004 (9,19 por 1.000). El 67% fueron preguntas al gobierno. La mayoría fueron tramitadas sin acuerdo o decisión (81%). Los hombres presentaron mayor probabilidad de incluir preguntas en sus iniciativas (OR = 17,08; IC del 95%, 5,91-55,62), pero las mujeres promovieron el 60% de las iniciativas sobre el tema. La probabilidad de preguntar fue mayor entre los miembros del gobierno (OR = 2,63; IC del 95%, 1,32-5,31), aunque la oposición lideró el 88% de las iniciativas. Conclusiones: En España, se ha producido una incipiente construcción política de la violencia de género que puede llevar al desarrollo de verdaderas estrategias. La actividad parlamentaria sobre el tema debería mantenerse a largo plazo, puesto que el problema persiste. ; Aims: To systematically examine the characteristics of the processes of formulating and taking decisions on gender-based violence in the Spanish Parliament. Methods: A search was performed for all parliamentary initiatives on gender-based violence in the Spanish parliament (1979-2004) and their qualitative content was analyzed. The ratio between initiatives on gender-based violence and those on other issues was calculated by years and legislatures. The probability of presenting initiatives on gender-based violence was analyzed by sex and political group (government vs. opposition) (odds ratio, 95% CI and statistical significance using the Mantel-Haenszel method). Results: In the 26 years studied, there were 322,187 initiatives, of which 569 concerned gender-based violence. Initiatives on this issue increased in 1998 (4.12 per 1,000), 2001 (4.49 per 1,000) and 2004 (9.19 per 1,000). Sixty-seven percent were questions to the government. The majority of the initiatives were registered without agreement or decision (81%). Men had a higher probability of asking questions (OR = 17.08; 95%CI, 5.91-55.62), but women instigated 60% of the initiatives. Parliamentary groups in government showed a higher probability of asking questions (OR = 2.63; 95%CI, 1.32-5.31), but 88% of the initiatives were promoted by the opposition. Conclusions: The process of policy construction has been started in Spain, which could lead to the development of true policies on gender-based violence in the future. Parliamentary activity on this issue should be maintained in the longterm, as the problem shows no sign of abating. ; Red de Investigación sobre Salud y Género (Instituto de Salud Carlos III); Instituto de la Mujer y Ministerio de Trabajo y Asuntos Sociales.

Desde la transición de España a la democracia, el aborto ha sido asunto de políticas públicas dentro y fuera del parlamento. En este artículo se describe la historia de la reforma de la ley de aborto en España desde 1979 hasta 2004, y se analiza el discurso sobre el aborto por parte de los parlamentarios españoles, por sexo y afiliación política. El análisis se basa en un estudio retrospectivo de la frecuencia de iniciativas legislativas y la prevalencia de diferentes argumentos y posiciones en debates sobre aborto, encontradas mediante una búsqueda sistemática en la base de datos parlamentaria. No se dedicó mucho tiempo al aborto en la agenda parlamentaria, comparado con otros asuntos relacionados con las mujeres, como la violencia contra éstas. Hubo 229 iniciativas parlamentarias en ese período, el 60% iniciadas y dirigidas por mujeres por el derecho a decidir; 143 diputadas y 72 diputados participaron en los debates. La aceptación de motivos socioeconómicos para tener un aborto legal (64%) y la legalización de la práctica de abortos a petición en el primer trimestre del embarazo (60%) fueron las formas más frecuentes propuestas para reformar la ley, principalmente a raíz de argumentos referentes a los derechos de las mujeres. Hombres y mujeres afiliados a partidos contra el derecho a decidir, y la mayoría de los hombres afiliados a otros partidos abogaron por los derechos del feto. Los partidos por el derecho a decidir presentaron más proyectos de ley que aquellos en contra, pero hasta ahora, se ha votado en contra de todas las reformas propuestas desde 1985. ; Since Spain's transition to democracy, abortion has been a public policy issue both inside and outside parliament. This paper describes the history of abortion law reform in Spain from 1979 to 2004 and analyses the discourse on abortion of members of the Spanish parliament by sex and political allegiance. The analysis is based on a retrospective study of the frequency of legislative initiatives and the prevalence of different arguments and positions in debates on abortion found through a systematic search of the parliamentary database. Little time was given to abortion in the parliamentary agenda compared to other women's issues such as violence against women. There were 229 bills and other parliamentary initiatives in that period, 60% initiated and led by pro-choice women. 143 female and 72 male parliamentarians took part in the debates. The inclusion of socio-economic grounds for legal abortion (64%), and making abortion on request legal in the first 12 weeks of pregnancy (60%) were the most frequent forms of law reform proposed, based most often on pro-women's rights arguments. Male and female members of anti-choice parties and most male members of other parties argued for fetal rights. Pro-choice parties tabled more bills than anti-choice parties but till now all reforms proposed since 1985 have been voted down. ; Depuis la transition de l'Espagne vers la démocratie, l'avortement est une question politique à l'intérieur et à l'extérieur du Parlement. Cet article retrace l'histoire de la réforme de la législation sur l'avortement en Espagne de 1979 à 2004 et analyse le discours des députés espagnols, par sexe et appartenance politique. L'analyse est fondée sur une étude de la fréquence des initiatives législatives et de la prévalence des différents arguments dans les débats sur l'avortement, effectuée à l'aide d'une recherche systématique dans la base de données parlementaire. Les travaux parlementaires ont consacré peu de temps à l'avortement par comparaison à d'autres questions intéressant les femmes, comme la violence contre les femmes. On a recensé 229 propositions de lois et autres initiatives parlementaires pendant cette période, dont 60% lancées et dirigées par des femmes favorables à l'avortement. Parmi les députés ayant participé au débat, il y avait 143 femmes et 72 hommes. L'inclusion de motifs socio-économiques pour l'avortement légal (64%) et la légalisation de l'avortement pendant les 12 premières semaines de grossesse (60%) étaient les propositions les plus fréquentes, basées le plus souvent sur le droit des femmes à choisir. Les membres masculins et féminins de partis opposés à l'avortement et la plupart des membres masculins d'autres partis militaient pour les droits du foetus. Les partis pour le libre choix ont présenté davantage de propositions de loi que les partis contre l'avortement, mais, depuis 1985, toutes les réformes ont été refusées. ; Spanish Research Network on Health and Gender, Institute of Health Carlos III, Ministry of Health, Spain

Geographical, socioeconomic and cultural factors contribute to high maternal mortality rates in developing countries

Los Objetivos de Desarrollo del Milenio (ODM) se encuentran actualmente a mitad de su periodo de ejecución, siendo el año 2015 la fecha prevista por la Organización de Naciones Unidas (ONU) para su alcance. El objetivo de este artículo es revisar la situación actual en la que se encuentran los ODM a nivel mundial y analizar las barreras que estarían impidiendo su consecución para cada uno de los ámbitos de los ODM, así como valorar algunos de los indicadores evaluados. Para ello, se ha revisado la literatura científica publicada sobre los ODM en las principales bases de datos de ciencias de la salud y ciencias sociales, así como los principales informes elaborados sobre el tema por Naciones Unidas. Los estudios científicos en torno a los 8 ODM y sus 18 Metas permiten realizar un análisis crítico sobre la situación en la que se encuentra en la actualidad cada uno de ellos, identificando los determinantes que están impidiendo su consecución y las acciones que se consideran necesarias para impulsar el avance. Aunque a nivel global ha habido mejoras en algunas de las metas, la investigación realizada hasta la fecha muestra barreras a la consecución de los ODM, como el insuficiente peso de los estados de los países en desarrollo sobre las decisiones económicas y políticas, así como la incoherencia entre las políticas económicas y las políticas sociales y de salud. Por otra parte, África Subsahariana constituye la región con mayor desventaja, lo que supone que no alcanzará la mayoría de los ODM. España y los países desarrollados, además de aportar recursos, pueden contribuir a los ODM mediante la identificación y erradicación de las barreras que impiden su alcance. Esto significa promover unas relaciones económicas internacionales en condiciones de justicia social, apoyando un mayor poder de decisión para los países en desarrollo, y denunciando las actuaciones que incrementan las desigualdades sociales y el empobrecimiento de la población. ; The Millennium Development Goals (MDGs) are now at the midterm of their target period, as 2015 is the date scheduled by the United Nations Organisation (UN) for their attainment. The purpose of this article is to review the current situation of the MDGs worldwide and to analyse the barriers which are preventing them from being attained in each of the MDG areas, as well as to assess a number of the indicators evaluated. In order to do so, a review has been made of the scientific literature published on the MDGs in the principal health sciences and social sciences databases, as well as the most significant reports on the issue drawn up by the United Nations. The scientific studies on the 8 MDGs and their 18 Targets make it possible to undertake a critical analysis of the situation in which each of these Goals are found at the present time, identifying the determinants that are preventing the attainment of the Goals and the actions considered necessary in order to achieve progress. Although there have been improvements in some of the goals on a world level, the research carried out to date reveals barriers to the attainment of the MDGs, as well as the insufficient weight of the developing countries in the economic and political decision-making processes, together with the incoherence between the economic policies and the social and health policies. Furthermore, Sub-Saharan Africa constitutes the most disadvantaged region, which means that it will not attain the majority of the MDGs. Spain and the developed countries, in addition to contributing resources, can also contribute to the MDGs by means of the identification and eradication of the barriers preventing attainment. This involves promoting international economic relations under conditions of social justice, by supporting a greater decision-making power for developing countries and denouncing actions that increase social inequalities and the impoverishment of the population.

Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study.

BACKGROUND: Corona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study. METHODS: This is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V). DISCUSSION: This study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine ...