Maternal Mortality In Africa Research Articles

Perception and reasons for the choice of informal provider among women receiving antenatal care services from traditional birth attendants in rural communities of Lagos state, Nigeria.

Unskilled delivery, particularly the use of traditional birth attendants, is a major threat to reducing maternal mortality in Africa. Despite the associated risks, there is insufficient evidence on the major reasons why pregnant women in Nigeria continue to use traditional birth attendant (TBA) services, especially in rural areas. This study, therefore, assessed the perception, reasons for use, and utilization of only TBA services in current pregnancy among rural-dwelling pregnant women in Lagos, Nigeria. A descriptive cross-sectional study was conducted among 347 pregnant women recruited from traditional birth attendant facilities at Ikorodu Local Government Area, Lagos. Data were collected with an interviewer-administered questionnaire and analyzed using SPSS version 25. Bivariate and multivariate analyses were conducted with a significance level set at p<0.05. The outcome measures included perception, utilization of only TBA services in current pregnancy, and reasons for use. Positive perception refers to positive thought, belief, or opinion held by the participants towards the TBA. All the respondents had a positive perception of TBAs, majority (70.3%) utilized TBA only while 29.7% combined TBA and healthcare facilities services in the current pregnancy. Recommendations from previous users (81.6%), welcoming and hospitable staff (77.2%), perceived spiritual protection (75.2%), and past use (68.6%), were some of the reasons cited by the respondents for utilizing only TBA services. Predictors of utilizing only TBA services were respondents' level of education, those with secondary (aOR = 0.261; 95% CI; 0.108-0.629) and tertiary (aOR = 0.352; 95% CI; 0.162-0.769) had lower utilization while the lack of health insurance coverage (aOR = 3.017; 95% CI; 1.476-6.166) were associated with higher utilization of TBAs. Respondents in this study had a positive perception of TBA services. Continuous training and an effective monitoring system of TBAs by the government and other healthcare stakeholders to improve women's birthing experiences is recommended.

Trends, Projections, and Regional Disparities of Maternal Mortality in Africa (1990-2030): An ARIMA Forecasting Approach.

With the United Nations Sustainable Development Goals (SDG) (2015-2030) focused on the reduction in maternal mortality, monitoring and forecasting maternal mortality rates (MMRs) in regions like Africa is crucial for health strategy planning by policymakers, international organizations, and NGOs. We collected maternal mortality rates per 100,000 births from the World Bank database between 1990 and 2015. Joinpoint regression was applied to assess trends, and the autoregressive integrated moving average (ARIMA) model was used on 1990-2015 data to forecast the MMRs for the next 15 years. We also used the Holt method and the machine-learning Prophet Forecasting Model. The study found a decline in MMRs in Africa with an average annual percentage change (APC) of -2.6% (95% CI -2.7; -2.5). North Africa reported the lowest MMR, while East Africa experienced the sharpest decline. The region-specific ARIMA models predict that the maternal mortality rate (MMR) in 2030 will vary across regions, ranging from 161 deaths per 100,000 births in North Africa to 302 deaths per 100,000 births in Central Africa, averaging 182 per 100,000 births for the continent. Despite the observed decreasing trend in maternal mortality rate (MMR), the MMR in Africa remains relatively high. The results indicate that MMR in Africa will continue to decrease by 2030. However, no region of Africa will likely reach the SDG target.

Addressing maternal mortality in Africa

Addressing maternal mortality in Africa

Maternal Mortality in Africa: Regional Trends (2000-2017).

Background: United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa’s leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa. Methods: We extracted data for maternal mortality rates per 100,000 births from the United Nations Children’s Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of −3.0% (95% CI −2.9; −3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations’ sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals. Conclusions: Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations’ target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.

Identifying interventions to reduce peripartum haemorrhage associated with caesarean delivery in Africa: A Delphi consensus study.

Women in Africa are fifty times more likely than in high-income settings to die following caesarean delivery, and peripartum haemorrhage is most strongly associated with mortality. We aimed to establish consensus on which interventions are considered most feasible to implement and most effective at reducing haemorrhage associated with caesarean delivery across Africa. We conducted a Delphi consensus study, including obstetric and anaesthesia providers from across Africa. In round one the expert group proposed key interventions for consideration. In rounds two and three the interventions were ranked on a 9-point Likert scale for effectiveness and feasibility. Round four was an online discussion to establish consensus on effectiveness and feasibility of interventions for which this had not been reached in round three. Twenty-eight interventions were considered both highly effective and feasible in Africa. Interventions covered a range of fields, categorised into direct- or indirect interventions. Direct interventions included: risk assessment and screening; checklists and protocols; monitoring and surveillance; availability of resources; ability to perform technical skills. Indirect interventions included: community and maternal education; contraception and family planning; minimum training standards; referral patterns and delays; advocacy to key stakeholders; simulation and team training; and 24-hour access to safe emergency caesarean delivery. Interventions considered both effective and feasible in reducing peripartum haemorrhage associated with caesarean delivery in Africa were identified. A multi-layered implementation strategy, including immediately developing a perioperative caesarean delivery bundle of care, in addition to longer-term public health measures may have a profound impact on maternal mortality in Africa.

Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries

BackgroundMaternal mortality remains a public health problem despite several global efforts. Globally, about 830 women die of pregnancy-related death per day, with more than two-third of these cases occurring in...

Significance of the George Macdonald Medal 1987 for Reproductive Health.

The doctrine now known as Sexual and Reproductive Health and Rights (SRHR) had a beginning and it is important that as advocates of the discipline that the African Journal of Reproductive Healt h describes its key and important developmental milestones from time to time. The George Macdonald Medal and its prize winner in 1987, Professor Kelsey Harrison is one of such important and critical milestones that should never be forgotten in the evolution of sexual and reproductive health as an international discipline. In this edition, we document who Professor George Macdonald was, why Professor Kelsey Harrison received an award in his memory in 1987, and why this award has come to be recognized as one of the driving forces for the emergence of the discipline of SRHR. The life and times of Professor Macdonald (Figure 1) have been well described and documented elsewhere 1 . In brief, before he died in 1967, he came to be recognized as one of the most pre-eminent figures in the field of tropical medicine worldwide. He graduated as a medical doctor from the University of Liverpool at the age of 21 years and rose rapidly to specialize in the field of public health, graduating with Diploma in Public Health and Doctor of Medicine in Liverpool in 1932. He worked as a malariologist, and led initial efforts to combat malaria with his establishment of the first global research laboratory on malaria. His works became significant especially because his era was a time when tropical medicine was hardly known in other parts of the world. He provided the first understanding of the social and medical circumstances under which people lived in the developing world and experienced malaria and other types of infectious diseases. He pioneered several successes in tropical medicine, including the device of an automatic flushing siphon for antimalarial drainage in Ceylon (now Sri Lanka). His research efforts led to the improved understanding of the modes of transmission of malaria and schistosomiasis through mathematical modeling and other high profile methods, which provided strong foundational basis for further works in the disciplines. In recognition of Professor Macdonald’s pioneering and innovative efforts in the field of tropical medicine he was honored jointly by the Royal Society of Tropical Medicine and Hygiene (RSTMH), UK, and the London School of Hygiene and Tropical Medicine (LSHTM), London, with the naming of a medal to be awarded to individuals who mirror his approach and philosophy of innovation and discovery in tropical medicine. In its website, the LSHTM describes the Macdonald Medal as “awarded every three years to recognize outstanding research leading to improvement of health in the tropics” 2 . Professor Kelsey Harrison (see Figure 2) was awarded the George Macdonald Medal on March 3, 1987 by the RSTMH and the LSHTM “for his outstanding contributions to solving the social and surgical problems of adolescent birth and high maternal mortality in Africa” (citation by the Dean of the LSHTM). The AJRH recognizes the Macdonald Medal as one of the most prestigious in the field of tropical medicine, and with the Nobel Prize yet to find a candidate for its award in tropical medicine, we recognize this award as one of the most groundbreaking and preeminent for practitioners of tropical medicine. The biography and the description of the life of Professor Kelsey Harrison (Figure 2) have been documented elsewhere 3 .

IMPACT OF MATERNAL MORTALITY ON SUSTAINABLE DEVELOPMENT IN THE SELECTED WEST AFRICAN COUNTRIES

Over half a million females die every year as a result of pregnancy and birth complications. The vast majority of these fatalities can be avoided. SDG 3.1’s objective is to reduce the global maternal mortality ratio by 2030 to below 70 per 100,000 live births. Despite a number of policies put in place maternal mortality in Africa remains unacceptably high. This study investigates the impact of maternal mortal- ity on sustainable development in 9 selected West African countries for the period from 1990 to 2015. Data used were adjusted net savings, maternal mortality, consumer price index, per-capita income and financial development. The second-generation econometric methods were employed: cross sectional dependence, slope homogeneity, Westerlund cointegration, Eberhadt and Teal AMG regression, and the Emirmahmutoglu and Kose bootstrap Granger causality test. Findings confirm the following: First, cross-sectional dependence and slope heterogeneity exist among the West African countries. Second, there is a long run relationship between maternal mortality and sustainable development. Third, maternal mortality impacted negatively and signifi- cantly on sustainable development. Fourth, the direction of causality varies across countries between maternal mor- tality and sustainable development. Lastly, causality runs from maternal mortality to sustainable development when analyzing the causal relationship among all countries. The findings suggest that the West African government needs to commit more funding to the health care sector and ensure access to free healthcare service to pregnant women or at low cost with quality and effective health care services if the countries must attain sustainable development by 2030.

Birth Preparedness and Complication Readiness among Pregnant Women Attending Antenatal Classes at Primary Health Center in Ibadan, Nigeria

Maternal mortality has been reported to be a challenge globally, with the highest maternal mortality in Africa. However, the first target for the third Sustainable Development Goal (SDG) is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. To achieve this goal, pregnant women’s knowledge of birth preparedness and complication readiness (BPCR) is a key. Therefore, this study set out to assess knowledge of birth preparedness and complication readiness among pregnant women attending antenatal classes. This pilot study adopted a descriptive cross-sectional study design using quantitative approach. Structured questionnaire was used to generate data from 46 respondents after obtaining ethical approval for the study. All data collected were adequate for data analysis. The mean age is 27.71 years with a standard deviation of 5.85, the average booking time was 4.69 months. Among the respondents who had given birth before, the average number of children was two children (1.8571). After categorizing the knowledge scores, 52.2% of the women have good knowledge of obstetric danger signs, 20 (43.5%) of the women have poor knowledge of BPCR and 32 (69.6%) of the respondents have good knowledge of skilled birth attendants. In conclusion, there is a need to formulate policies and strategies that will help to improve pregnant women’s knowledge of BPCR if the first target of the third SDG will be achieved.

Developing norms and standards on maternal mortality in Africa: lessons from UN human rights bodies

ABSTRACT: The African Charter on Human and Peoples’ Rights and the Protocol to the African Charter Human and Peoples’ Rights on the Rights of Women in Africa (African Women’s Rights Protocol) contain useful provisions for addressing maternal mortality as a human rights violation. In addition, the African Union and its organs have recognised maternal mortality as a violation of the rights of women in Africa through initiatives such as the Campaign on Accelerated Reduction of Maternal Mortality in Africa; the African Commission on Human and Peoples’ Rights (African Commission) Resolution 135 on Maternal Mortality in Africa; as well as the African Commission’s General Comment on the Right to Life. Both the African Court on Human and Peoples’ Rights and the African Commission are now set to apply these frameworks in their jurisprudence and engagements with States. However, despite these developments, a significant number of African women die every year due to complications arising from pregnancy or childbirth. These deaths are avoidable if African governments have lived up to their obligations under international and regional human rights instruments. This article addresses pertinent experiences from the United Nations human rights system and analyses the key lessons learned from their approaches to addressing maternal mortality as a human rights issue, to strengthen the African system’s jurisprudence and legal frameworks.&#x0D; &#x0D; TITRE ET RÉSUMÉ EN FRANÇAIS: Le développement de normes et standards relatifs à la mortalité maternelle en Afrique: leçons apprises des organes des droits de l’homme des Nations Unies RÉSUMÉ: La Charte africaine des droits de l’homme et des peuples et le Protocole à la Charte africaine des droits de l’homme et des peuples relatif aux droits des femmes en Afrique (Protocole relatif aux droits des femmes en afrique) contiennent des dispositions utiles pour traiter la mortalité maternelle comme une violation des droits humains. En outre, l’Union africaine et ses organes ont reconnu la mortalité maternelle comme une violation des droits des femmes en Afrique à travers des initiatives telles que la Campagne pour la réduction accélérée de la mortalité maternelle en Afrique; la Résolution 135 de la Commission africaine des droits de l’homme et des peuples (Commission africaine) sur la mortalité maternelle en Afrique; ainsi que l’Observation générale de la Commission africaine sur le droit à la vie. La Cour africaine des droits de l’homme et des peuples et la Commission africaine peuvent désormais appliquer ces normes dans leur jurisprudence et dans leurs relations avec les Etats. Cependant, malgré ces développements, un nombre important de femmes africaines meurent chaque année en raison de complications liées à la grossesse ou à l’accouchement. Ces décès sont évitables si les gouvernements africains respectent leurs obligations en vertu des instruments internationaux et régionaux relatifs aux droits de l’homme. Le présent article traite des expériences pertinentes du système des droits de l’homme des Nations Unies et analyse les principaux enseignements tirés des approches par lesquelles ce système traite la mortalité maternelle en tant que question de droits de l’homme pour renforcer la jurisprudence et les cadres juridiques du système africain.

The Associations between Types of Ambient PM2.5 and Under-Five and Maternal Mortality in Africa.

Exploring the effects of different types of PM2.5 is necessary to reduce associated deaths, especially in low- and middle-income countries (LMICs). Hence we determined types of ambient PM2.5 before exploring their effects on under-five and maternal mortality in Africa. The spectral derivate of aerosol optical depth (AOD) from Moderate Resolution Imaging Spectroradiometer (MODIS) products from 2000 to 2015 were employed to determine the aerosol types before using Generalized Linear and Additive Mixed-Effect models with Poisson link function to explore the associations and penalized spline for dose-response relationships. Four types of PM2.5 were identified in terms of mineral dust, anthropogenic pollutant, biomass burning and mixture aerosols. The results demonstrate that biomass PM2.5 increased the rate of under-five mortality in Western and Central Africa, each by 2%, and maternal mortality in Central Africa by 19%. Anthropogenic PM2.5 increased under-five and maternal deaths in Northern Africa by 5% and 10%, respectively, and maternal deaths by 4% in Eastern Africa. Dust PM2.5 increased under-five deaths in Northern, Western, and Central Africa by 3%, 1%, and 10%, respectively. Mixture PM2.5 only increased under-five deaths and maternal deaths in Western (incidence rate ratio = 1.01, p < 0.10) and Eastern Africa (incidence rate ratio = 1.06, p < 0.01), respectively. The findings indicate the types of ambient PM2.5 are significantly associated with under-five and maternal mortality in Africa where the exposure level usually exceeds the World Health Organization’s (WHO) standards. Appropriate policy actions on protective and control measures are therefore suggested and should be developed and implemented accordingly.

Emergency obstetric care in a rural district of Burundi: What are the surgical needs?

ObjectivesIn a rural district hospital in Burundi offering Emergency Obstetric care-(EmOC), we assessed the a) characteristics of women at risk of, or with an obstetric complication and their types b) the number and type of obstetric surgical procedures and anaesthesia performed c) human resource cadres who performed surgery and anaesthesia and d) hospital exit outcomes.MethodsA retrospective analysis of EmOC data (2011 and 2012).ResultsA total of 6084 women were referred for EmOC of whom 2534(42%) underwent a major surgical procedure while 1345(22%) required a minor procedure (36% women did not require any surgical procedure). All cases with uterine rupture(73) and extra-uterine pregnancy(10) and the majority with pre-uterine rupture and foetal distress required major surgery. The two most prevalent conditions requiring a minor surgical procedure were abortions (61%) and normal delivery (34%).A total of 2544 major procedures were performed on 2534 admitted individuals. Of these, 1650(65%) required spinal and 578(23%) required general anaesthesia; 2341(92%) procedures were performed by ‘general practitioners with surgical skills’ and in 2451(96%) cases, anaesthesia was provided by nurses. Of 2534 hospital admissions related to major procedures, 2467(97%) were discharged, 21(0.8%) were referred to tertiary care and 2(0.1%) died.ConclusionOverall, the obstetric surgical volume in rural Burundi is high with nearly six out of ten referrals requiring surgical intervention. Nonetheless, good quality care could be achieved by trained, non-specialist staff. The post-2015 development agenda needs to take this into consideration if it is to make progress towards reducing maternal mortality in Africa.

Using advocacy and data to strengthen political accountability in maternal and newborn health in Africa

Accountability mechanisms help governments and development partners fulfill the promises and commitments they make to global initiatives such as the Millennium Development Goals and the Global Strategy on Women’s and Children’s health, and regional or national strategies such as the Campaign for the Accelerated Reduction in Maternal Mortality in Africa (CARMMA). But without directed pressure, comparative data and tools to provide insight into successes, failures, and overall results, accountability fails. The analysis of accountability mechanisms in five countries supported by the Evidence for Action program shows that accountability is most effective when it is connected across global and national levels; civil society has a central and independent role; proactive, immediate and targeted implementation mechanisms are funded from the start; advocacy for accountability is combined with local outreach activities such as blood drives; local and national champions (Presidents, First Ladies, Ministers) help draw public attention to government performance; scorecards are developed to provide insight into performance and highlight necessary improvements; and politicians at subnational level are supported by national leaders to effect change. Under the Sustainable Development Goals, accountability and advocacy supported by global and regional intergovernmental organizations, constantly monitored and with commensurate retribution for nonperformance will remain essential.

Neglecting human ecology: The common element of global health failures.

Attempts to control malaria, AIDS, and maternal mortality in Africa have been woefully inadequate. This has involved adopting an almost exclusively technical preventive approach in the context of AIDS even though emphasizing human behavior holds the most promise. But on the other hand, it has also involved abandoning highly effective technical measures, as in the case of malaria. This suggests that the failure, at root, is anthropological in nature. The common element, it is argued here, is the failure to place the human ecology resolutely above destructive ideologies. Sound public-health approaches have been spurned in favor of predetermined preventive approaches in the service of ideological aims rather than of man and the common good. This article examines the ideological forces that have ultimately driven global health policy, and proposes that a more humane anthropology would be beneficial. Lay Summary: The scourges of malaria, AIDS, and maternal mortality have persisted in Africa, even though sensible and available means of addressing these epidemics, when stressed, have met with success. The reluctance to consistently emphasize the soundest public-health approaches-whether technical or behavioral in nature-indicate that global health policy has to a large extent been improperly concerned with advancing ideological agendas. The challenge we face today is not primarily technical but philosophical; the healing professions would perform a service by cultivating a higher view of man and an appreciation for objective moral truths that protect him.

Maternal mortality in Africa: investigating more, acting more.

Maternal mortality in Africa: investigating more, acting more.

The question of autonomy in maternal health in Africa: a rights-based consideration.

Maternal mortality is still very high in Africa, despite progress in control efforts at the global level. One elemental link is the question of autonomy in maternal health, especially at the household level where intrinsic human rights are undermined. A rights-based consideration in bioethics is an approach that holds the centrality of the human person, with a compelling reference to the fundamental human rights of every person. A philosophical and sociological engagement of gender and the notion of autonomy within the household reveals some fundamental rights-based perplexities for bioethical considerations in maternal health. The right to self-determination is undermined, and therefore women's dignity, freedom and autonomy, capacities, and choices are easily defiled. This study applies a rights-based approach to maternal health and demonstrates how rights concerns are associated with negative outcomes in maternal health in Africa. The discussion is situated at the household level, which is the starting point in health care. The paper submits that beyond legal and political rights within the context of the state, rights-based issues manifest at the household level. Many of those rights issues, especially relating to women's autonomy, are detrimental to maternal health in Africa. Therefore, a rights-based approach in the social construction of maternal health realities will contribute to alleviating the burden of maternal mortality in Africa.

The Association between Maternal Mortality and Non-Medical factors in African Countries

The medical expertise to treat to complications arising from pregnancy and childbirth has not spared girls and women in developing countries from dying of such conditions. Developing countries account for the bulk of the global share of maternal deaths with complications of pregnancy and childbirth being the leading cause of death in young women aged between 15 and 49. Sub-Saharan Africa is responsible for nearly three-fifths of all global maternal deaths which have saddled it with notoriously high levels of maternal mortality ratios, a concern that has been red-flagged internationally and regionally. Most studies on maternal mortality in Africa have been confined to an examination of factors impinging on maternal mortality from both medical and socioeconomic standpoints for individual country’s based on survey data. Our study differs from others as it employs logistic regression to look at the association between non-medical factors and maternal mortality nationally for all African countries. Whilst the results from the logistic regression suggests that there is no statistically significant relationship between any of the variables and maternal mortality, the odds ratio for Human Development Index (HDI) and Gross National Income per capita (GNI) imply that African countries with low HDI are about three time more likely to have high maternal mortality compared to high HDI countries. Similarly, African countries with low GNI are about five times more likely to have high maternal mortality compared to high GNI countries.

Time series analysis of maternal mortality in Africa from 1990 to 2005

ObjectivesMost global maternal deaths occur in Africa and Asia. In response, the Millennium Development Goal (MDG-5) calls for a 75% reduction in maternal mortality from 1990 to 2015. To assess...

Crossing the divide: expanding the scope of operational research in Public Health Action.

Public Health Action (PHA) was launched over a year ago, with a notable goal of becoming a home for operational research originating from low- and middle-income countries, and to become a vehicle for disseminating research that will provide health solutions for poor and vulnerable populations. Making health systems work for such groups is bound to face challenges, and there is a need to show what works and what does not, and to find solutions. Paradoxically, it is here, where a culture of inquiry is essential, that research capacity is most lacking. This issue of PHA covers a number of operational research studies that focus on childhood nutrition and child and maternal mortality. These studies were conducted by young researchers trained through operational research courses run by the International Union Against Tuberculosis and Lung Disease and Medecins Sans Frontieres,1 some of whom are publishing for the first time. These papers are unique in that they originate from conflict and slum settings. We welcome such submissions because they cross the traditional geographic divide of where research comes from, thus expanding the diversity of PHA. Two papers touch on chronic childhood under-nutrition, a relatively neglected area of research. The studies by Ali et al.2 and Shams et al.3 look at operational issues related to anthropometric measurements in a slum setting in Dhaka, Bangladesh. The study from Ali et al. shows that World Health Organization growth charts4 used as the basis for determining proxy heights for age are inappropriate in contexts of prevalent stunting. It would exclude one in ten vulnerable children from nutritional assessments, and underestimate malnutrition prevalence in nutritional surveys. There is thus a need to adapt existing charts to national settings. Similarly, the study by Shams et al. shows that, among children presenting to primary care facilities, there was four times more severe chronic malnutrition compared to severe acute malnutrition. The message here is that existing guidelines for malnutrition should also include severe chronic malnutrition, and that tackling it will need to go beyond routine practice, to thinking outside the box. The studies by van den Boogaard et al.5 and Tamura et al.6 address child and maternal mortality in Africa, a continent where there is inadequate progress towards achieving Millennium Development Goals 4 and 5. van den Boogaard et al. assess paediatric in-patient mortality (an indicator of quality of care) in a large cohort of under-five children in eight hospitals in Africa, and show that while mortality rates were within acceptable limits, new ways to implement and/or adapt care packages to address neonatal care and sepsis are needed. Finally, Tamura et al. add to the literature on severe maternal morbidity and mortality in conflict and post-conflict countries, highlighting the role of a referral service in improving access in addition to providing emergency obstetric care at hospitals. The encouraging overall message of these papers is that health care services can be offered and improved in conflict and deprived settings. In the quest to achieve universal health coverage, implementation and operational research will need to be embraced so that vulnerable populations are not left out.

I092 ROLE OF MIDWIVES IN REDUCING MATERNAL MORTALITY IN AFRICA

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S183-S183 Invited presentations and presentations by organisations and societies I092 ROLE OF MIDWIVES IN REDUCING MATERNAL MORTALITY IN AFRICA J.A. Dennis-Antwi, J.A. Dennis-AntwiSearch for more papers by this author J.A. Dennis-Antwi, J.A. Dennis-AntwiSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)60122-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S183-S183 RelatedInformation