Why Aren’t There More Maternal Deaths? A Decomposition Analysis

Globally, the number of maternal deaths remains large, and the risk per birth is high in the developing world. Deaths declined between 1990 and 2008, despite the 42% increase in women. We decompose selected determinants to help explain the decline. Numbers of women, births, and fertility rates come from the UN; maternal mortality ratios are from the UN and from Hogan et al. Decomposition isolates the effects of additional women, decreases in fertility, and declines in mortality ratios, also in rates. Women aged 15–49 increased by 42%, but births remained constant due to declining fertility rates. The fertility decline alone averted approximately 1.7 million deaths, 1990–2008. The risk per birth (MMR) also fell, adding to the decline in the number of deaths. Exceptional declines occurred in the maternal mortality rate. Sub-Saharan Africa has experienced minimal declines in deaths, due to increases in women and small declines in fertility and mortality. The growing numbers of women have made international efforts to reduce the number of maternal deaths ever more challenging. Comparatively little attention has been given to the offsetting effect of the historic fertility declines in the developing world, and hence a flat trend in births. The maternal mortality ratio has also fallen, reflecting the success of direct maternal health efforts. Programs that provide couples with the means to control their fertility can reinforce fertility declines. These programs are companions to ongoing, direct measures to reduce the risk of death once pregnant

Training and Support of Developing-Country Population Scientists: A Panel Report

This report offers an assessment of the current situation and needs for the future with regard to training population professionals. As the concerns of population scientists become more diverse and as institutions look beyond the limitations of their own programs, collaborative training programs are increasingly seen as an effective means of maximizing the training experience of students while potentially lowering overall costs. While it is clear that the most desirable situation is one in which population experts are trained primarily in high-quality institutions located in their own countries or regions, it is equally clear that this scenario is not likely to be achieved in the near future. Moreover, until career opportunities for trained population scientists improve in the developing world, many of those trained outside their own country may not return after their training is complete. The report includes recommendations focusing on graduate-level education and support for highly trained population professionals, directed toward three of the primary actors in the training of population scientists: 1) universities providing graduate training in population, 2) professional associations of population scientists, and 3) donors supporting population scientists in developing countries

Validating indicators of the quality of maternal health care: Final report, Mexico

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To help accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate the indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. Women’s self-report of obstetric and immediate postnatal maternal and newborn care received was compared against a “gold standard” of observations by a trained third-party observer during labor and delivery. This report presents results of the Mexico study

Who Is Doing the Research? The Implications of the Pandemic for Researchers in the Population Sciences

This essay explores widening gender gaps in research productivity during the pandemic, long-term career impacts for those entering the field, and potential trends in education and employment

Training and support of developing-country population scientists: A panel report—Summary and recommendations

From its earliest days, the Population Council has recognized the importance and value of training population scientists from developing countries. Since 1952, the Council’s social science fellowship program has sustained a commitment to this goal; approximately 1,500 fellowships have been awarded for pre- and postdoctoral training in population studies. While the demand for population scientists remains strong, the field has changed substantially since those early years and a review of the program was needed. The Mellon Foundation funded a project in 2000 to assess future needs for training and support of population scientists from developing countries and assembled an international panel of experts. The panel’s mandate was to conduct a detailed examination of the current situation with respect to recruitment, training, funding, and employment of population scientists. On the basis of this assessment, the panel sought to identify gaps and make recommendations. The results of the panel’s work are contained in a detailed report. The main conclusions and recommendations of that report are summarized in the present document

The changing context of sexual initiation in sub-Saharan Africa

This working paper investigates the links between changing age at marriage and premarital sexual behavior in 27 sub-Saharan African countries in which Demographic and Health Surveys were conducted between 1994 and 2003. Using multiple-decrement life tables to examine the competing risks of premarital sex and marriage without prior sexual experience, we answer the largely unaddressed question of how reductions in the prevalence of early marriage have affected the likelihood of initiating premarital sex. Our analysis reveals that although the age of first sexual activity has either remained the same or increased, a shift in the context of sexual debut from marriage to before marriage has taken place in many countries. We assess whether the increase in the proportion of young women who report premarital sex is influenced by an increase in exposure resulting from delayed marriage or by an increase in the rate of premarital sex. The evidence on this point is mixed; in some settings greater exposure “explains” more of the increase, whereas in others an increased rate of premarital sex dominates

Validating indicators of the quality of maternal health care: Final report, Kenya

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. Women’s self-report of obstetric and immediate postnatal maternal and newborn care received was compared against a “gold standard” of observations by a trained third-party observer during labor and delivery. This report presents results of the Kenya study

Validation studies for population-based intervention coverage indicators: design, analysis, and interpretation.

BACKGROUND: Population-based intervention coverage indicators are widely used to track country and program progress in improving health and to evaluate health programs. Indicator validation studies that compare survey responses to a "gold standard" measure are useful to understand whether the indicator provides accurate information. The Improving Coverage Measurement (ICM) Core Group has developed and implemented a standard approach to validating coverage indicators measured in household surveys, described in this paper. METHODS: The general design of these studies includes measurement of true health status and intervention receipt (gold standard), followed by interviews with the individuals observed, and a comparison of the observations (gold standard) to the responses to survey questions. The gold standard should use a data source external to the respondent to document need for and receipt of an intervention. Most frequently, this is accomplished through direct observation of clinical care, and/or use of a study-trained clinician to obtain a gold standard diagnosis. Follow-up interviews with respondents should employ standard survey questions, where they exist, as well as alternative or additional questions that can be compared against the standard household survey questions. RESULTS: Indicator validation studies should report on participation at every stage, and provide data on reasons for non-participation. Metrics of individual validity (sensitivity, specificity, area under the receiver operating characteristic curve) and population-level validity (inflation factor) should be reported, as well as the percent of survey responses that are "don't know" or missing. Associations between interviewer and participant characteristics and measures of validity should be assessed and reported. CONCLUSIONS: These methods allow respondent-reported coverage measures to be validated against more objective measures of need for and receipt of an intervention, and should be considered together with cognitive interviewing, discriminative validity, or reliability testing to inform decisions about which indicators to include in household surveys. Public health researchers should assess the evidence for validity of existing and proposed household survey coverage indicators and consider validation studies to fill evidence gaps

Six-Month Mortality among HIV-Infected Adults Presenting for Antiretroviral Therapy with Unexplained Weight Loss, Chronic Fever or Chronic Diarrhea in Malawi.

In sub-Saharan Africa, early mortality is high following initiation of antiretroviral therapy (ART). We investigated 6-month outcomes and factors associated with mortality in HIV-infected adults being assessed for ART initiation and presenting with weight loss, chronic fever or diarrhea, and with negative TB sputum microscopy