Tackling high maternal death rates

A team from the University of Southampton will soon (29 January) be travelling to Yemen in the Middle East to establish a National Confidential Enquiry into maternal death rates. The country has one of the highest maternal mortality rates in the world-1,700 per 100,000 live births.

Jane Diamond and Dr Will Stones from the Department of Social Statistics will lead the pioneering project aimed at reducing maternal mortality. Jane said: "Delivery practices in Yemen are poor with around 90% of births taking place at home, usually without the assistance of trained medical attendants. It is estimated that the Government healthcare system probably reaches less than half the population and even then the quality of care is inconsistent. Whilst Mother and Child Health (MCH) services have been integrated into the primary healthcare system, only a relatively small percentage of the population has access to MCH services."

Tackling the high maternal mortality rates is likely to involve a cultural change according to Jane: "The majority of women have little choice in deciding where to give birth, and their extended family often decides for them. Yemeni women also have a fear of modern childcare facilities. According to many observations the vast majority of uneducated and socially under-privileged women generally appear to feel uneasy with the modern MCH approach." Jane added: "Women in Yemen think they are in a vulnerable position in personal as well as socio-economic terms. Delivering outside of the home means that they will leave behind the traditional area of control and familiarity. With 75% of Yemen's population living in rural areas, accessibility to most MCH services in geographical as well as economic and cultural terms is far from optimal for the majority of women."

The National Confidential Enquiry is being piloted in a hospital in the Yemeni capital, Sana'a, and will involve the establishment of a monthly clinical review meeting of doctors, nurses and non-clinical personnel to review case notes of all women who died that month or who suffered serious complications. Its aim is to engender a climate of confidentiality and confidence in order for staff to talk freely about how a case was managed. It is hoped that the review meetings will lead to the adoption and implementation of improved standards of care, and regular review of the attainment of such standards.

Following an evaluation of the pilot project, the project will be expanded to a further four hospitals.

Recommendations for the establishment of a National Confidential Enquiry will be made during Phase II of the project.

To complement the hospital-based initiatives, Jane Diamond will in addition be undertaking qualitative research into men's and women's perceptions of hospital- based obstetric services in the communities served by the hospitals in which the project is being implemented. Service providers will also be asked their views of community perceptions and of the implications of changes in practice as a result of the enquiry.