Health care for all mothers and infants by 2000 AD.

Abstract

Although the future health of a nation depends largely on the health care provided for mothers and infants, little emphasis is placed on maternal and child health (MCH) care in the health programs of most countries. In some developing countries up to 70% of women fail to receive any form of health care during pregnancy and childbirth, and the newborns are left to the care of their mothers. Even in developed countries there are pockets of population which remain untouched by such programs. In Singapore, increased literacy, greater health consciousness, and a successful family planning program have contributed to a decline in the crude birth rate from 42.7 to 16.9 between 1967-78 and a decrease in the mean birth order to 1.75. Maternal mortality rates, like infant and perinatal mortality rates, vary widely in different countries and within countries, and leave room for improvement almost everywhere. Childbrith remains the main cause of death in women aged 14-45 years in the developing world, where anemia and intercurrent infections contribute to obstetric complications. Nearly 1 billion people in the developing world are trapped in a vicious circle of poverty, malnutrition, disease and despair. There are 4 major reasons for the failure of countries to provide MCH care: 1) shortage of resources 2) maldistribution of existing manpower 3) poor utilization of existing facilities, and 4) inadequate or inappropriate training of health manpower. Because of perceived health manpower shortages, 493 new medical schools were established throughout the world between 1955-75, 350 of them in developing countries. 608 of the world's 1124 medical schools are now in developing countries, but despite the effort and money invested, the ratio of physicians to population has not imporved significantly and the gross maldistribution of available health personnel within countries continues. The total health manpower available is 1/130 population in developed countries, 1/500 in developing countries, and 1/2400 in the least developed countries. Migration of physicians has aggravated the shortage in some countries. The infant mortality rate in most developing countries ranges from nearly 100 to 200/1000, compared to 10-20 in developed countries. Malnutrition, infectious diseases, and high fertility are 3 major causes of high infant and child mortality. Community participation is crucial if MCH care is to be available to rural communities. Health care should become a part of the total socioeconomic development of a country. All existing health personnel including traditional practitioners should be utilized and, if necessary, retrained. Training should be objective and task of oriented.