High Total Fertility Rate Research Articles

Practice and Intention to use long acting and permanent contraceptive methods among married women in Ethiopia: Systematic meta-analysis.

BackgroundThe long acting and permanent contraceptive methods (LAPCMs) has not used unlike that of short-acting methods in Ethiopia. Ethiopia is the second most populous country in Sub Saharan Africa with a high total fertility rate, and high maternal and child mortality rates. This study summarized the evidence of practice and intention to use long acting and permanent family planning methods among women in Ethiopia using systemic review and meta-analysis.MethodsA systematic review and meta-analysis of the published and unpublished observational studies were conducted. Original studies were identified using databases of Medline/Pubmed, and Google Scholar. Heterogeneity across studies was checked using Cochrane Q test statistic and I2test. The pooled proportion of intention to use and the practice of long acting and permanent contraceptive methods were computed using a/the random effect model.ResultsBased on the ten observational studies included in the meta-analysis, the pooled prevalence of intention to use long acting and permanent contraceptive methods among married women according to the random effect model was 42.98 % (95 % CI 32.53, 53.27 %). On the other hand, the pooled practice of long acting and permanent methods of contraceptive among the study participants was 16.64 % (95 % CI 12.4 to 20.87 %).ConclusionThis meta-analysis revealed that women’s intention to use LAPCMs is generally good but their utilization is low. It is recommended, therefore, that LAPMCs must be made more readily available and accessible to women at the lower level of health service delivery who are in need of it.

The low prevalence of female smoking in the developing world: gender inequality or maternal adaptations for fetal protection?

Background: Female smoking prevalence is dramatically lower in developing countries (3.1%) than developed countries (17.2%), whereas male smoking is similar (32% vs 30.1%). Low female smoking has been linked to high gender inequality. Alternatively, to protect their offspring from teratogenic substances, pregnant and lactating women appear to have evolved aversions to toxic plant substances like nicotine, which are reinforced by cultural proscriptions. Higher total fertility rates (TFRs) in developing countries could therefore explain their lower prevalence of female smoking.Objective: To compare the associations of TFR and gender inequality with national prevalence rates of female and male smoking.Methods: Data from a previous study of smoking prevalence vs gender inequality in 74 countries were reanalysed with a regression model that also included TFR. We replicated this analysis with three additional measures of gender equality and 2012 smoking data from 173 countries.Results: A 1 SD increase in TFR predicted a decrease in female smoking prevalence by factors of 0.58–0.77, adjusting for covariates. TFR had a smaller and unexpected negative association with male smoking prevalence. Increased gender equality was associated with increased female smoking prevalence, and, unexpectedly, with decreased male smoking prevalence. TFR was also associated with an increase in smoking prevalence among postmenopausal women.Conclusions: High TFR and gender inequality both predict reduced prevalence of female smoking across nations. In countries with high TFR, adaptations and cultural norms that protect fetuses from plant toxins might suppress smoking among frequently pregnant and lactating women.

High infant mortality rate, high total fertility rate and very low female literacy in selected African countries.

This study focused on the top 10 selected African countries with key interventions such as high infant mortality rate, high total fertility rate and female literacy rate. The World Bank's 2013 data were used. Descriptive analyses were performed. Findings show that Sierra Leone (107.2), Angola (102) and Central Africa Republic (96.1) reported the highest infant mortality rate per 1000 live births. The total fertility rates in Niger (7.6), Mali (6.8) and Somalia (6.6) were higher than other comparable countries. Health care service providers need to pay more attention during pregnancy periods, improve number of field visits, identify pregnant women and promote 100% antenatal care if this is done practically, these countries will reduce and ultimately eliminate infant mortality.

Fertility Patterns of Native and Migrant Muslims in Europe

This study focuses on Muslim fertility in Europe. Evidence from 25 countries suggests that the Muslim total fertility rate is on average 47% higher than the national level. However, we find a significant difference in the level of fertility of native-born Muslims and immigrant Muslims. The native-born have a 19% higher total fertility rate, while immigrants have 62% higher fertility. Our main research question is whether religion is an important determinant of fertility outcome, or whether the other characteristics that are specific for Muslims in Europe (e.g. socio-economics, migrant status, and religiosity) determine the observed difference in fertility. To answer this question, we focus on three case studies: Spain, where most Muslims are immigrants; Bulgaria, where most Muslims are native; and Greece, which has significant shares of both recent migrants and native Muslims. Our findings suggest that the immigrant status of Muslims and their socio-economic status are more important than religion in terms of explaining their high fertility. Copyright © 2015 John Wiley & Sons, Ltd.

Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda’s Southern Kayonza District

While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective. We undertook a qualitative study of community perceptions of reproductive health and family planning in Rwanda's southern Kayonza district, which has the country's highest total fertility rate. From October 2011 to December 2012, we conducted interviews with randomly selected male and female community members (n = 96), community health workers (n = 48), and health facility nurses (n = 15), representing all 8 health centers' catchment areas in the overall catchment area of the district's Rwinkwavu Hospital. We then carried out a directed content analysis to identify key themes and triangulate findings across methods and informant groups. Key themes emerged across interviews surrounding: (1) fertility beliefs: participants recognized the benefits of family planning but often desired larger families for cultural and historical reasons; (2) social pressures and gender roles: young and unmarried women faced significant stigma and husbands exerted decision-making power, but many husbands did not have a good understanding of family planning because they perceived it as a woman's matter; (3) barriers to accessing high-quality services: out-of-pocket costs, stock-outs, limited method choice, and long waiting times but short consultations at facilities were common complaints; (4) side effects: poor management and rumors and fears of side effects affected contraceptive use. These themes recurred throughout many participant narratives and influenced reproductive health decision making, including enrollment and retention in family planning programs. As Rwanda continues to refine its family planning policies and programs, it will be critical to address community perceptions around fertility and desired family size, health worker shortages, and stock-outs, as well as to engage men and boys, improve training and mentorship of health workers to provide quality services, and clarify and enforce national policies about payment for services at the local level.

Emergency contraception in post-conflict Somalia: assessing awareness and perceptions of need

Abstract Background The national health system in Somalia has been seriously undermined by almost two decades of civil war and conflict. Somalia's high total fertility rate, high maternal mortality ratio, and low contraceptive prevalence rate coupled with restrictive abortion laws make addressing the lack of family planning services an important priority. In crisis and conflict or post-conflict settings such as Somalia, emergency contraception can be important for pregnancy prevention, yet Somalia remains one of the few countries in the world without a registered progestin-only emergency contraceptive pill. In 2014, we conducted fieldwork in Somalia to explore awareness of and attitudes to emergency contraception. Methods We conducted a qualitative, multi-methods study comprised of ten formal, semi-structured interviews with key informants (ie, physicians, non-governmental officials, and government officials) in Mogadishu, structured, in-person interviews with 20 Somali pharmacists in a range of neighbourhoods, and four focus group discussions with 21 married and unmarried Somali women. Most key informants and pharmacists were purposively sampled, with additional participants recruited through snowball sampling. Focus group participants were recruited through our study's partner non-governmental organisations in Mogadishu. Findings from this study will be disseminated to stakeholders in the form of a summarised report and will inform future projects and policies about the potential expansion of emergency contraception in Somalia. Findings Responses from most participants showed little knowledge of existing family planning methods or emergency contraception. However, once emergency contraception was described, all participants expressed tremendous enthusiasm for expanding access to post-coital contraceptive methods in Somalia. They believed that the provision of emergency contraception would fill a major gap in reproductive health service delivery. All stakeholders involved in the study identified ways that emergency contraception could be incorporated into the health system. Interpretation Although importation and use of pharmaceuticals in Somalia is severely unregulated, and measures for formal registration of medications in Somalia do not exist, results from our study highlight mechanisms that could be explored to expand access to emergency contraception in Somalia. This study sheds much needed light on why Somalia continues to be a global exception with respect to a dedicated product and suggests that there are possible avenues for overcoming existing barriers. Funding This study has received funding from the Society of Family Planning's Research Fund, as well as the Faculty of Graduate and Post-doctoral Studies at the University of Ottawa.

Macro Determinants of Infant Mortality in ECO Countries: Evidence from Panel Data Analysis

Background Infant mortality rate is widely used to assessing the health status of population in both developing and developed countries. The aim of this study was to identify the main factors affect infant mortality rate in ECO countries for the years 2005 to 2012. Methods A panel data model from ECO countries from 2005 to 2012 used to identify the some of key explanatory variables (GDP per capita, female labour participation rate, public expenditure as % of total health expenditure and total fertility rate) effect on infant mortality rate. These data was obtained from World Bank and World Health Organization. The data analyzed by STATA v.12. Results This study indicated the GDP per capita and public spending had a negative and significant effect on infant mortality in studied countries. A higher total fertility rate is also associated with higher infant mortality. In addition, our analysis showed there is not association between female labour participation rate and infant mortality. Conclusions GDP per capita, public expenditure as % of total health expenditure and total fertility rate were identified as the main determinant of infant mortality in ECO countries in study period. We hope the results of current study provide useful information for health policy- makers to better understand the main factors affecting on infant mortality.

Perceptions of Couples Who Use Jadelle Implant in Blantyre District, Malawi

Malawi has a high total fertility rate of 5.7 per woman and Jadelle implant may be an ideal option for couples who want to practice family planning. Jadelle is a long term contraceptive which is inserted just under the skin of a woman’s upper, inner arm by a nurse or midwife and prevents a woman from getting pregnant for a period of five years. But the use of Jadelle for family planning depends on perceptions of couples. The purpose of this study was to explore the perceptions of couples who choose Jadelle as their family planning method at a Central Hospital in Blantyre district. This study used a descriptive qualitative design. A purposive sample of 5 couples was used. Ethical clearance was granted by relevant authorities. Data was analysed through content analysis. The findings showed that the following nine themes emerged from the qualitative data: 1) men and women perspectives about mode of action of Jadelle; 2) knowledge about effectiveness and efficacy of Jadelle among men and women; 3) sources of information about Jadelle; 4) information given to Jadelle users by providers; 5) benefits of Jadelle; 6) challenges associated with Jadelle; 7) myths associated with Jadelle; 8) attitudes of providers of Jadelle and 9) role played by men regarding use of Jadelle. In conclusion, this study found that both men and women generally lacked knowledge of Jadelle. Men play a vital role when couples are choosing contraceptives. Every opportunity should be utilised at antenatal, postnatal and family planning clinics to teach individuals about family planning. This may allow women and men to make informed choices about the use of Jadelle.

Immigrant Fertility in Germany: The Role of Culture

This paper focuses on the role of home country’s fertility culture in shaping immigrants’ fertility. I use the German Socio-Economic Panel (SOEP) to study completed fertility of first-generation immigrants who arrived from different countries and in different years. The variation in total fertility rates (TFRs) across countries and over time serves as a proxy for cultural changes. By using a linear fixed-effects approach, I find that women from countries with high TFRs have significantly more children than women from countries with low TFRs. I also demonstrate that this positive relationship is attenuated by potential selection that operates towards the destination country. In addition, home country’s TFRs explain a large proportion of fertility differentials between immigrants and German natives. The results suggest that home country’s culture affects immigrants’ long-run outcomes, thereby supporting the socialization hypothesis.

English

Unless evidence based decisions are made based on local contexts, the low prevalence level of contraceptive use and the corresponding higher total fertility rate will make Ethiopia to remain the most populous country in Africa. The purpose of this study was to assess the status of modern contraceptive use among married women in Debre Birhan district, Ethiopia. A community based cross-sectional study was conducted among married women of reproductive age. Systematic random sampling technique was used to choose 851 study subjects. Before data collection, ethical clearance was obtained from the institution, and data was collected by trained diploma nurses using pretested structured questionnaire and analyzed by statistical package for social sciences (SPSS), version 20. Logistic regression analysis was employed to identify the predictors of modern contraceptive use. Modern contraceptive prevalence rate among married women was 46.9%. Injectables were the most frequently used type of modern contraceptive method (62.9%), followed by intrauterine device (16.8%), pills (14%), norplant (4.3%), male condom (1.2%) and female sterilization (0.8%). Multiple logistic regression model revealed that the need to have more children [AOR 95% CI: 9.27 (5.43 to 15.84)], husband approval [AOR 95% CI: 2.82 (1.67 to 4.80)] and husband-wife communication about contraceptives [AOR 7.32, 95% CI (3.60 to 14.86)] were found to be an independent predictors for the use of modern contraceptives. There were no statistical significant differences between modern contraceptive use and other socio-demographic and reproductive health related variables after an adjustment. Modern contraceptive use declined among married women in the district. The culture of publicly discussing the use of contraceptives and breaking the silence among the people demands substantial efforts. Considering users of contraceptives as deviant also requires paradigm shift in thinking. Key words: Debre-Birhan, married women, modern contraceptive, use.

Challenges in sexual and reproductive health of Roma people who live in settlements in Serbia

Objective To investigate the differences in sexual and reproductive health (SRH) between Roma women of reproductive age who live in settlements and the general population of women of the same age in Serbia who do not live in settlements. Methods The Multiple Indicator Cluster Survey 4 (MICS4) was administered to Roma and Serbian women and the results were compared between the two groups. In order to get a qualitative perspective, a specifically designed, short open-ended questionnaire about Roma women was given to Roma Health Mediators (RHMs). Results Roma women have a higher total fertility rate and adolescent birth rate, and early marriage is much more common among them. Differences are less clear regarding antenatal care and assistance during delivery from skilled personnel. Roma women more frequently rely on traditional contraception, and are less likely to use modern contraceptives than the general female population. Problems in the socio-economic sphere, poor school enrolment and maintenance of traditional patterns in Roma people living in settlements contribute to the disparities observed. Conclusion Although data on the SRH of the general population of women in Serbia are far from being satisfactory, those for women who live in Roma settlements are much worse. Political actions aimed at the empowerment of Roma women in the spheres of education, employment and health promotion have been implemented with the hope that they might improve the SRH of this vulnerable population group. Chinese 摘要 目的 调查研究生活在塞尔维亚居留地的罗马育龄期女性与非居留地的同龄女性间性生殖健康（SRH）方面的差异。 方法 对罗马女性与塞尔维亚女性分别进行多指标类集调查4（The Multiple Indicator Cluster Survey, MICS4）并比较调查结果。为进行定性研究，我们提供给罗马健康调解员（RHMs）为罗马女性特殊设计的、简短的、开放性的问卷。 结果 罗马女性的总生育率与青少年分娩率更高，且早婚现象更为常见。在专业人员产前保健及分娩助产方面的差异不甚明确。罗马女性更倾向于传统避孕方法，与整体女性相比新型避孕药的使用率更低。居留地罗马居民面对的社会经济问题、低教育率以及坚持传统模式等因素可导致以上差异。 结论 整体塞尔维亚女性的性生殖健康（SRH）相关数据要比居留地罗马女性相关数据令人满意得多。政府已展开行动维护居留地罗马女性在教育、就业及健康方面的权利，这也许可以提高该脆弱群体的性生殖健康。

Reasons for persistently high maternal and perinatal mortalities in Ethiopia: Part II-Socio-economic and cultural factors.

The major causes of maternal and perinatal deaths are mostly pregnancy related. However, there are several predisposing factors for the increased risk of pregnancy related complications and deaths in developing countries. The objective of this review was to grossly estimate the effect of selected socioeconomic and cultural factors on maternal mortality, stillbirths and neonatal mortality in Ethiopia. A comprehensive literature review was conducted focusing on the effect of total fertility rate (TFR), modern contraceptive use, harmful traditional practice, adult literacy rate and level of income on maternal and perinatal mortalities. For the majority of the data, regression analysis and Pearson correlation coefficient were used as a proxy indicator for the association of variables with maternal, fetal and neonatal mortality. Although there were variations in the methods for estimation, the TFR of women in Ethiopia declined from 5.9 to 4.8 in the last fifteen years, which was in the middle as compared with that of other African countries. The preference of injectable contraceptive method has increased by 7-fold, but the unmet contraceptive need was among the highest in Africa. About 50% reduction in female genital cutting (FGC) was reported although some women's attitude was positive towards the practice of FGC. The regression analysis demonstrated increased risk of stillbirths, neonatal and maternal mortality with increased TFR. The increased adult literacy rate was associated with increased antenatal care and skilled person attended delivery. Low adult literacy was also found to have a negative association with stillbirths and neonatal and maternal mortality. A similar trend was also observed with income. Maternal mortality ratio, stillbirth rate and neonatal mortality rate had inverse relations with income and adult education. In Ethiopia, the high total fertility rate, low utilization of contraceptive methods, low adult literacy rate, low income and prevalent harmful traditional practices have probably contributed to the high maternal mortality ratio, stillbirth and neonatal mortality rates.

Commentary: Reasons for Persistently High Maternal and Perinatal Mortalities in Ethiopia: Part III–Perspective of the “Three Delays” Model

From the experience of high-income countries, the occurrence of all obstetric complications may not be preventable but almost all are treatable before resulting in serious maternal and perinatal morbidity and mortality (1, 2). The interventions may start at preconception; however, providing optimal obstetric care for all pregnant women starting from early pregnancy up to the end of puerperium has paramount significance in the reduction of maternal and perinatal deaths. Specific to low and middle-income countries, improving the intrapartum monitoring and access to a cesarean section and blood transfusion were highly recommended as key interventions to reduce maternal and perinatal deaths (3, 4). According to the Federal Ministry of Health of Ethiopia 2011/2012 Health and Health Related Indicators report, however, the proportion of at least four visits antenatal care was 19%; total births attended by skilled health personnel were 16.6%; and the proportion of cesarean delivery was about 1% (5), while the WHO cesarean delivery recommendation is 5%–15% for the general population (6). These reports indicate the big gap in utilizing reproductive health services before and after conception. In addressing issues regarding maternal and perinatal death rates, the “three delay” model is frequently used to consider factors that may be obstacles for women receiving appropriate medical care. The three delay model was initially proposed by Thaddeus and Maine in 1990 (7). The components of this model include the delays of the decision to seek health care (8), the ability to get access to a health facility (9) and receiving medical care timely and appropriately once the facility is reached (10). It is generally recognized that diminished access to facilities providing emergency obstetric care contributes to increased maternal and perinatal mortality (11, 12). The purpose of this review was to look into the high maternal and perinatal mortality from the perspective of the three delays models and to show the complexity and interlink of predisposing factors for maternal and perinatal deaths. As discussed in other articles (13, 14), the factors for high maternal and perinatal mortality in the last three decades were multidimensional (the extremely low number of health facilities and health professionals, low adult literacy rate, low utilization of contraceptive methods, high total fertility rate, high early marriage and adolescent pregnancy, low antenatal care service, low skilled person attended deliveries, and rampant harmful traditional practices). The main focus of this review is the “Delay Model”. To summarize these complex and interlinked factors for the increased risk of maternal and perinatal deaths in Ethiopia, a simplified schematic presentation from the perspective of the “three delays” model (Figure 1). As a complimentary, two more schematic presentations were developed from the perspective of “etiologic” factors (Figure 2), and to show the multidimensional nature of maternal mortality (Figure 3). Open in a separate window Figure 1 Contextual factors that contribute to high maternal and perinatal mortality in Ethiopia, using the “Delay model”

Immigrant Fertility in Germany: The Role of Culture

This paper focuses on the role of home country’s fertility culture in shaping immigrants’ fertility. I use the German Socio-Economic Panel (SOEP) to study completed fertility of first-generation immigrants who arrived from different countries and in different years. The variation in total fertility rates (TFRs) across countries and over time serves as a proxy for cultural changes. By using a linear fixed-effects approach, I find that women from countries with high TFRs have significantly more children than women from countries with low TFRs. I also demonstrate that this positive relationship is attenuated by potential selection that operates towards the destination country. In addition, home country’s TFRs explain a large proportion of fertility differentials between immigrants and German natives. The results suggest that home country’s culture affects immigrants’ long-run outcomes, thereby supporting the socialization hypothesis. <bold>Zusammenfassung</bold> Diese Studie befasst sich mit dem Geburtenverhalten von Migrantinnen der ersten Generation. Unter Verwendung der Daten des Sozio-oekonomischen Panels (SOEP) wird die endgültige Kinderzahl der Zuwanderinnen als abhängige Variable und die kulturelle Prägung aus dem Heimatland als Determinante modelliert. Zur Messung der “Fertilitätskultur” wird als Proxy die mittlere Differenz zwischen der zusammengefassten Geburtenziffer (total fertility rate – TFR) des Ursprungslandes und der von Deutschland zum Zeitpunkt der Migration verwendet. Die Schätzergebnisse eines linearen Fixed-Effects-Ansatzes zeigen, dass Fertilitätskultur einen signifikanten Anteil der Fertilitätsunterschiede zwischen Einheimischen und Migranten erklärt und positiv mit der endgültigen Kinderzahl der Migrantinnen korreliert. Ergänzende Analysen legen nahe, dass der positive Zusammenhang durch potenzielle Selektion tendenziell unterschätzt wird. Die Befunde unterstreichen die sogenannte Sozialisationshypothese, welche besagt, dass die kulturelle Prägung des Ursprungslandes das Verhalten von Migranten dauerhaft beeinflusst. <italic>JEL Classification: J13, J15, Z10, Z13</italic>

Demand for long acting and permanent contraceptive methods and associated factors among married women of reproductive age group in Debre Markos Town, North West Ethiopia

BackgroundEthiopia is the second most populous country in sub Saharan Africa with high total fertility rate, and high maternal and child mortality rates. In sub Saharan African countries, including Ethiopia, even though studies show that demand for contraception is high, the practice is low. Particularly, in Ethiopia, despite the fact that practices on long acting and permanent methods are believed to be low, there are limited evidences on the real magnitude of demand for the methods.MethodsTo assess demand for long acting and permanent contraceptive methods and associated factors among married women of reproductive age group in Debre Markos town, Amhara Regional State, North West Ethiopia, A community based cross sectional study was conducted, from April 08–19, 2012. Systematic sampling technique was used to select 523 study participants. Pre tested structured Amharic version questionnaire was used to collect the data through interview. Both bivariate and multiple logistic regressions were used to identify associated factors.ResultsAmong 519 respondents, 323 (62.2%) were using modern family planning (FP) methods in which 101 (19.5%) were using long acting and permanent contraceptive methods (LAPMs). Among all respondents, 171 (32.9%) had unmet need for LAPMs. The total demand for LAPMs was 272 (52.4%) of which 37.1% were satisfied and 62.9% unsatisfied demand. Being in the older age group (40-44 years) [AOR = 2.8; 95% CI:1.12, 9.55], having no desire for more child [AOR = 20.37; 95% CI:9.28, 44.72], desire to have a child after 2 years [AOR = 6.4; 95%CI:3.04,13.47], not ever heard of modern FP [AOR = 5.73; 95% CI:1.26, 25.91], not ever using of modern FP [AOR = 1.89; 95% CI:1.01, 3.55] and having no spousal discussion in the last six month [AOR = 1.642, 95% CI: 1.049, 2.57) were some of the factors significantly associated with demand for LAPMs.ConclusionsDemand and unmet need for LAPMs were high in the study area. Therefore raising awareness of the community, counseling/discussion about the methods with all clients, encouraging spousal involvement are fundamental areas of intervention. Moreover, increasing the availability and accessibility of LAPMs is required to meet the unmet needs.

Use of Modern Contraception and Fertility: Some Results about Krenak Indigenous People, Brazil

Indigenous populations living in villages in Brazil have presented high total fertility rates (TFR) that have increased over time, particularly in Amazon peoples. Virtually nothing is known on indigenous fertility levels in villages located in other regions of Brazil. The objective of this article is to examine the use of modern contraception and fertility among Krenak women, who reside in the state of Minas Gerais, Southeast Brazil. The data used in this work were produced from the survey “Spatial Distribution of Malnutrition of the Child Population and of the Prevalent Nosology for the 2000 to 2006 Period”. The description of the fertility of the Krenak women was performed by calculating the TFR for the period between 2003 and 2007 and of cohort, and the information about the use of contraceptives was also gathered directly through the questionnaire. The TFR for the period between 2003 and 2007, in the Krenak indigenous land, was 3.6 children per woman, whereas the TFR for cohort – for women aged 50 or more, was 7.5 children. The most common contraceptive method used among Krenak women is the birth control pill (55.6%). Taking into account evidences from Amazon peoples, our results show low level of fertility among Krenak women. Such a result can be partially explained by the relatively high prevalence of contraceptive use of modern methods. Furthermore, it is probable that other variables could explain such differences, such as education and health access.

Evaluating the impact a proposed family planning model would have on maternal and infant mortality in Afghanistan

This study aimed to assess the potential impact a proposed family planning model would have on reducing maternal and infant mortality in Afghanistan. Afghanistan has a high total fertility rate, high infant mortality rate, and high maternal mortality rate. Afghanistan also has tremendous socio-cultural barriers to and misconceptions about family planning services. We applied predictive statistical models to a proposed family planning model for Afghanistan to better understand the impact increased family planning can have on Afghanistan's maternal mortality rate and infant mortality rate. We further developed a sensitivity analysis that illustrates the number of maternal and infant deaths that can be averted over 5 years according to different increases in contraceptive prevalence rates. Incrementally increasing contraceptive prevalence rates in Afghanistan from 10% to 60% over the course of 5 years could prevent 11,653 maternal deaths and 317,084 infant deaths, a total of 328,737 maternal and infant deaths averted. Achieving goals in reducing maternal and infant mortality rates in Afghanistan requires a culturally relevant approach to family planning that will be supported by the population. The family planning model for Afghanistan presents such a solution and holds the potential to prevent hundreds of thousands of deaths.

Coverage of intermittent preventive treatment and insecticide-treated nets for the control of malaria during pregnancy in sub-Saharan Africa: a synthesis and meta-analysis of national survey data, 2009–11

Pregnant women in malaria-endemic countries in sub-Saharan Africa are especially vulnerable to malaria. Recommended prevention strategies include intermittent preventive treatment with two doses of sulfadoxine-pyrimethamine and the use of insecticide-treated nets. However, progress with implementation has been slow and the Roll Back Malaria Partnership target of 80% coverage of both interventions by 2010 has not been met. We aimed to review the coverage of intermittent preventive treatment, insecticide-treated nets, and antenatal care for pregnant women in sub-Saharan Africa and to explore associations between coverage and individual and country-level factors, including the role of funding for malaria prevention. We used data from nationally representative household surveys from 2009-11 to estimate coverage of intermittent preventive treatment, use of insecticide-treated nets, and attendance at antenatal clinics by pregnant women in sub-Saharan Africa. Using demographic data for births and published data for malaria exposure, we also estimated the number of malaria-exposed births (livebirths and stillbirths combined) for 2010 by country. We used meta-regression analysis to investigate the factors associated with coverage of intermittent preventive treatment and use of insecticide-treated nets. Of the 21·4 million estimated malaria-exposed births across 27 countries in 2010, an estimated 4·6 million (21·5%, 95% CI 19·3-23·7) were born to mothers who received intermittent preventive treatment. Insecticide-treated nets were used during pregnancy for 10·5 million of 26·9 million births across 37 countries (38·8%, 34·6-43·0). Antenatal care was attended at least once by 16·3 of 20·8 million women in 2010 (78·3%, 75·2-81·4; n=26 countries) and at least twice by 14·7 of 19·6 million women (75·1%, 72·9-77·3; n=22 countries). For the countries with previous estimates for 2007, coverage of intermittent preventive treatment increased from 13·1% (11·9-14·3) to 21·2% (18·9-23·5; n=14 countries) and use of insecticide-treated nets increased from 17·9% (15·1-20·7) to 41·6% (37·2-46·0; n=24 countries) in 2010. A fall in coverage by more than 10% was seen in two of 24 countries for intermittent preventive treatment and in three of 30 countries for insecticide-treated nets. High disbursement of funds for malaria control and a long time interval since adoption of the relevant policy were associated with the highest coverage of intermittent preventive treatment. High disbursement of funds for malaria control and high total fertility rate were associated with the greatest use of insecticide-treated nets, whereas a high per-head gross domestic product (GDP) was associated with less use of nets than was a lower GDP. Coverage of intermittent preventive treatment showed greater inequity overall than use of insecticide-treated nets, with richer, educated, and urban women more likely to receive preventive treatment than their poorer, uneducated, rural counterparts. Although coverage of intermittent preventive treatment and use of insecticide-treated nets by pregnant women has increased in most countries, coverage remains far below international targets, despite fairly high rates of attendance at antenatal clinics. The effect of the implementation of WHO's 2012 policy update for intermittent preventive treatment, which aims to simplify the message and align preventive treatment with the focused antenatal care schedule, should be assessed to find out whether it leads to improvements in coverage. Bill & Melinda Gates Foundation.

Global Statistics of Perinatal Medicine

Aim: To clarify improvements in maternal and perinatal mortalities in the world. Methods: Calculation of UNICEF data, quotation of reference and statistical analysis. Results: Global maternal mortality was slightly improved; along with the increase of countries of maternal mortality lower than 20, while the mean global mortality more than 20 was unchanged, and the highest maternal mortality were 2,000. Maternal mortality was high in high total fertility rate and low when total fertility rate was less than 3. Maternal mortality was high when less than 5, mortality was high. Maternal mortality was reported to be significantly lower when the birth space was 36 or more months. Perinatal mortality was reported only in limited countries, while the mortality was closely correlated to maternal mortality. Thus, perinatal mortality was estimated from maternal mortality, where mild improvement was noted in the increase of countries of low estimated mortality, and the peak of estimated perinatal mortality decreased from 130 to 120. Conclusion: Maternal mortality was slightly improved, but it was unchanged in high mortality countries. The mortality was low in low total fertility rate. Perinatal mortality was estimated from maternal mortality, because they were closely correlated.

Governance and Provision of Health Security: A Case Study of the Implementation of the National Rural Health Mission Programme in East Khasi Hills District of Meghalaya

The provision of human security in terms of food and health by the Government is an important indicator of good governance. This is more so in a state which is largely rural in nature, where the poverty level is high and the basic access to healthcare facilities is negligible. The health indicators in the state of Meghalaya are not too impressive. Infant Mortality Rate is as high as 55(SRS 2011) and it is reported that one in every four children is severely underweight (NFHS 3). To add to this the health indicators of women is also far from good. The state has a high Maternal Mortality Rate as well as high Total Fertility Rate. The NRHM Vision (20052012) has identified Meghalaya as one of the states having weak public health indicators and infrastructure. The weak health indicators and infrastructure bears testimony to the fact that until and unless the Government takes a more proactive role, large group of the marginalized section will not enjoy any form of health security. In this context therefore it becomes important for us to understand the role played by the National Rural Health Mission (NRHM) in ensuring health security to the marginalised group. Both primary and secondary sources have been used. Primary sources included government reports and document; while Secondary sources included the use of reference books and newspapers.