UNFPAState of World Population 2004
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State of World Population
Population and Poverty
Population and the Environment
Migration and Urbanization
Gender Equality and Women's Empowerment
Reproductive Health and Family Planning
Maternal Health
Preventing HIV/AIDS
Adolescents and Young People
Reproductive Health for Communities in Crisis
Action Priorities
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Maternal Health

New Approaches
Causes and Consequences
Maternal Morbidity
Obstetric Fistula
Reducing Maternal Mortality and Morbidity
Difficulties in Measurement
Holistic Responses
Antenatal Care
Skilled Attendance
Emergency Obstetric Care
Post-abortion Care
Quality of Maternal Health
Men and Maternal Health
UNFPA and Safe Motherhood

Quality of Maternal Health

As with family planning, quality is also important in maternal health programmes,(61) and can increase the likelihood that women facing obstetric emergencies will go to health facilities for life-saving care. A study of 164 households in Mexico where a maternal death occurred found that perceived quality of health care was a significant factor in a woman in labour delaying seeking medical care.(62)

Other studies found similar concerns among potential users. In Bolivia, women say they consider respectful treatment to be crucial and that condescending provider attitudes are the greatest deterrent to the use of maternal health services.(63) A study in Yemen of randomly selected households found that both rural and urban women preferred to deliver at home, despite acknowledging the importance of their medical needs, because they feared bad experiences or had prior bad experiences with institutional deliveries.(64)

Since the ICPD, attention to quality services has increased significantly, and many countries have launched initiatives to improve maternal health care. For example, with donor assistance, Azerbaijan initiated a Safe Motherhood and Newborn Care project, which includes capacity-building of health staff, raising the awareness of women and adolescent girls regarding healthy lifestyles, promoting a mother- and baby-friendly environment at maternity units, and giving special attention to vulnerable populations. Several governments in the Caribbean have established maternal and child health committees or technical advisory groups, whose members include doctors, nurses and social workers.(65)

Training providers is an important element in providing improved care and overcoming clients’ reservations about seeking out available services. It can also have positive impacts on maternal health outcomes.(66) For example, a training programme in Moldova led to sites welcoming fathers or family members as support persons for women in labour, maternity hospitals allowing family visits post-partum, women reporting a decline in invasive practices, and more parents attending new childbirth classes.(67)

And after 24 trainers were trained in the Ukraine, induction of labour and Caesarean sections were less frequent, and providers reported that they felt that the women giving birth were happier.(68) Training providers in Russia resulted in a huge increase in clients spending the night in a hospital following delivery, from 0.5 per cent to 86 per cent one year later.(69)


At a MaxSalud primary health clinic in a peri-urban community in Peru, health managers were concerned by low utilization rates in 2000 among their mostly female clientele. An assessment found that women were reluctant to get reproductive health services from the male gynaecologist after the midwife transferred to another clinic. Prices were reduced, an aggressive publicity campaign was launched to advertise the new fees, and a certified midwife was reinstated as part of the clinic’s quality improvement intervention. Service utilization rates rose dramatically. Female clients reported high satisfaction with women’s health services and a preference for female providers. See Sources

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