This article looks to the past to consider how government officials, health professionals, and legal authorities have historically framed racial disparities in birth and the lasting impact these explanations have had on Black birthing experiences and outcomes.

Why do some global health initiatives receive priority from international and national political leaders while others receive minimal attention? We propose a framework for analyzing this question consisting of four categories of factors: the strength of the actors involved in the initiative, the power of the ideas they use to frame the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself.We apply this framework to the case of a global initiative to reduce (...) maternal mortality, launched in 1987. Using a process-tracing methodology commonly employed in qualitative research, we conducted archival research and interviewed actors involved in the initiative. We find that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's twentieth anniversary year, 2007, presents opportunities to build political momentum. To generate political priority advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue that convinces political leaders to act.We draw on the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, a subject that has attracted much speculation but little scholarship. (shrink)

This paper examines the association of the sociodemographic characteristics of women and the unobserved hospital factors with maternal mortality in Kenya using multilevel logistic regression. The data analysed comprise hospital records for 58,151 obstetric admissions in sixteen public hospitals, consisting of 182 maternal deaths. The results show that the probability of maternal mortality depends on both observed factors that are associated with a particular woman and unobserved factors peculiar to the admitting hospital. The individual characteristics (...) observed to have a significant association with maternal mortality include maternal age, antenatal clinic attendance and educational attainment. The hospital variation is observed to be stronger for women with least favourable sociodemographic characteristics. For example, the risk of maternal death at high-risk hospitals for women aged 35 years and above, who had low levels of education, and did not attend antenatal care is about 280 deaths per 1000 admissions. The risk for similar women at low-risk hospitals is about 4 deaths per 1000. To complement results from the analysis of individual patient records, the paper includes findings from hospital staff reports regarding the maternal mortality situation at the hospitals. (shrink)

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; (...) and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal. (shrink)

Child mortality (the mortality of children less than five years old) declined considerably in the developing world in the 1990s, but infant mortality declined less. The reductions in neonatal mortality were not impressive and, as a consequence, there is an increasing percentage of infant deaths in the neonatal period. Any further reduction in child mortality, therefore, requires an understanding of the determinants of neonatal mortality. 209,628 birth and 2581 neonatal death records for the 1998 (...) birth cohort from the city of São Paulo, Brazil, were probabilistically matched. Data were from SINASC and SIM, Information Systems on Live Births and Deaths of Brazil. Logistic regression was used to find the association between neonatal mortality and the following risk factors: birth weight, gestational age, Apgar scores at 1 and 5 minutes, delivery mode, plurality, sex, maternal education, maternal age, number of prior losses, prenatal care, race, parity and community development. Infants of older mothers were less likely to die in the neonatal period. Caesarean delivery was not found to be associated with neonatal mortality. Low birth weight, pre-term birth and low Apgar scores were associated with neonatal death. Having a mother who lives in the highest developed community decreased the odds of neonatal death, suggesting that factors not measured in this study are behind such association. This result may also indicate that other factors over and above biological and more proximate factors could affect neonatal death. (shrink)

This study explores the factors associated with neonatal mortality and maternal health care in Nepal. The subjects were 4375 births reported in the 1996 Nepal Family Health Survey. Maternal and child health care was found to have a significant association with neonatal mortality, although preceding birth interval and sex of child had stronger effects. Four aspects of maternal care were found to be highly associated with region, household ownership of assets, mothers education. This indicates that (...) accessibility, affordability and availability of maternal health care are important factors to consider in future research on neonatal mortality. (shrink)

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. (shrink)

Extrinsic mortality is a key influence on organisms’ life history strategies, especially on age at maturity. This historical longitudinal study of 125 women in rural Domenica examines effects of extrinsic mortality on human age at maturity and pace of reproduction. Extrinsic mortality is indicated by local population infant mortality rates during infancy and at maturity between the years 1925 and 2000. Extrinsic mortality shows effects on age at first birth and pace of reproduction among these (...) women. Parish death records show huge historical variation in age-specific mortality rates. The infant mortality rate (IMR) in the early 1920s was low, increased dramatically beginning in 1929, and reached a maximum in the 1950s, at which point IMR declined steadily to its present low rate. The mortality rate early in life showed a quadratic association with age at first birth. Women who experienced conditions of low IMR early in life reproduced relatively late in life. Those born into moderately high levels of infant mortality tended to reproduce earlier than those born at low levels. At very high infant mortality levels early in life, women went on to delay reproduction until relatively late, possibly as a result of somatic depletion and energetic stress associated with the conditions that lead to high IMR. Population mortality rates at age of maturity also showed a quadratic association with age at first birth. The pace of reproduction, estimated as number of surviving offspring controlled for maternal age, showed a similar quadratic effect. There were complex interactions between population mortality rates in infancy and at maturity. When extrinsic mortality was high during infancy, extrinsic mortality later in life had little effect on timing of first birth. When extrinsic mortality was low to moderate in infancy, extrinsic mortality later in life had significant effects on adult reproduction. I speculate that these effects are mediated through development of personality facets associated with reproduction. (shrink)

Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh and examines its determinants. Data from a baseline survey of UP Community Mobilization project was utilized. A cross-sectional sample of currently married women who delivered a baby 15 months prior to the survey was included. Information (...) was collected from 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care, delivery and postnatal care services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group membership had no association with the utilization of maternal health services. Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group. (shrink)

Historical foundations rooted in reproductive oppression have implications for how racism has been integrated into the structures of society, including public policies, institutional practices, and cultural representations that reinforce racial inequality in maternal health. This article examines these connections and sheds light on how they perpetuate both racial disparities in maternal health and high rates of maternal mortality and morbidity among Black women.

This article explores the effectiveness of the decision of the Committee on the Elimination of Discrimination against Women in the case of Alyne da Silva Pimentel Teixeira (deceased) v. Brazil, concerning a poor, Afro-Brazilian woman. This is the first decision of an international human rights treaty body to hold a state accountable for its failure to prevent an avoidable death in childbirth. Assessing the future effectiveness of this decision might be undertaken concretely by determining the degree of Brazil's actual compliance (...) with the Committee's recommendations, and how this decision influences pending domestic litigation arising from the maternal death. Alternative approaches include: determining whether, over time, the decision leads to the elimination of discrimination against women of poor, minority racial status in the health sector, and if it narrows the wide gap between rates of maternal mortality of poor, Afro-Brazilian women and the country's general female population. Determining the effectiveness of this decision will guide whether to pursue a more general strategy of judicializing maternal mortality. (shrink)

This study examines whether mortality of two adjacent siblings in families is age-specific and is modified by the MCH78, 198590 in the treatment (MCH–FP) and comparison areas. Logistic regression was used to estimate the net effects of survival status of elder siblings on mortality of younger siblings in the neonatal, postneonatal and toddler periods, controlling for birth order, previous birth interval, maternal age, education and religion, household possession of valuable items and sex of the child.

Black women are 3–4 times more likely to die from a pregnancy‐related complication and twice as likely to experience severe maternal morbidity when compared to white women in the United States. The risks for pregnancy‐related maternal mortality are well documented, yet Black women's experiences of life‐threatening morbidity are essentially absent in the nursing literature. The purpose of this interpretive phenomenological study was to understand the experiences of Black women who developed severe maternal morbidity. Face‐to‐face, one‐to‐one, in‐depth (...) conversational interviews were conducted with nine Black women who experienced life‐threatening complications during childbirth or postpartum. Five essential themes emerged (1) I Only Know What I Know; (2) How You Cared for Me; (3) Race Matters; (4) Faced with Uncertainty; and (5) Still Healing. These themes illuminate the complexity of Black women's subjective interpretations of severe maternal morbidity, and reveal ways in which racism, not race, places Black women at risk for poor maternal health outcomes. The author envisions greater equity for Black mothers entrusted to nursing care, guided by nursing theories informed by these study findings. (shrink)

Maternal health has become a top global priority. In contrast to the decline of the maternal subject (Stephens, 2011), and despite previous evidence that maternal health has struggled to find a place on the global policy agenda (Shiffman and Smith, 2007), it is now clear that the promotion of health for mothers and children is a staple of both government and private donor commitments. On humanitarian grounds, it makes sense to focus on maternal health and survival (...) in the Global South. Death related to pregnancy or childbirth is a disheartening example of needless suffering. But beyond the initial impulse to reduce suffering, what motivates and/or requires action for addressing injustice in the form of distributional inequities for maternal and reproductive health? In this article, I make a case for the necessity and validity of transnational cooperation to address maternal mortality and morbidity in the Global South. The first component of my argument addresses the transnational elements of both global interconnectedness and responsibility to act. These elements are drawn from Iris Marion Young’s philosophical justification for North-South responsibility-taking. The second component of my argument adds the concept of affective solidarity to that of transnational responsibility. My argument in this section draws from Iris Marion Young’s earlier work on identity (Young, 1990) and embodiment (Young, 1984) and expands the analysis of affective solidarity as a form of both embodiment and political commitment in order to explain the mechanism for transnational connection and understanding. And the final component of my argument explains how both of these elements – transnational responsibility and affective solidarity – support a theory of transnational maternal feminism. (shrink)

The aim of this study is an analysis of the possible adaptive consequences of delivery of low birth weight infants. We attempt to reveal the cost and benefit components of bearing small children, estimate the chance of the infants’ survival, and calculate the mothers’ reproductive success. According to life-history theory, under certain circumstances mothers can enhance their lifetime fitness by lowering the rate of investment in an infant and/or enhancing the rate of subsequent births. We assume that living in a (...) risky environment and giving birth to a small infant may involve a shift from qualitative to quantitative production of offspring. Given high infant mortality rates, parents will have a reproductive interest in producing a relatively large number of children with a smaller amount of prenatal investment. This hypothesis was tested among 650 Gypsy and 717 non-Gypsy Hungarian mothers. Our study has revealed that 23.8% of the Gypsy mothers had low birth weight (<2,500 g) children, whose mortality rate is very high. These mothers also had more spontaneous abortions and stillbirths than those with normal weight children. As a possible response to these reproductive failures, they shortened birth spacing, gaining 2–4 years across their reproductive lifespan for having additional children. Because of the relatively short interbirth intervals, by the end of their fertility period, Gypsy mothers with one or two low birth weight infants have significantly more children than their ethnic Hungarian counterparts. They appear to compensate for handicaps associated with low birth weights by having a larger number of closely spaced children following the birth of one or more infants with a reduced probability of survival. The possible alternative explanations are discussed, and the long-term reproductive benefits are estimated for both ethnic groups. (shrink)

At the beginning of the twentieth century the high mortality rates of both mothers and babies during childbirth became a predominant concern in Britain and its empire, provoking outcries from medical and nursing professionals as well as politicians and the wider public. Infant mortality became the new marker of the vitality of the nation and a widely used indicator of general standards of health. Efforts to improve maternal and infant welfare were part of a broader shift in (...) Britain towards public health as a government responsibility. Measures taken to reduce mortality rates emphasized state-run initiatives in maternal education and antenatal care, the medicalization of childbirth, and scientific infant feeding and childrearing practices. This shift in health care policies resulted in profound changes to the experience of childbirth and to the role of the state in the area of social welfare... (shrink)

Pregnancy is thought to be a metabolically very expensive endeavor, yet investigations have produced inconsistent results concerning the responsiveness of human birth weight to maternal nutritional stress or nutritional intervention. These findings have led some researchers to conclude that fetal growth is strongly buffered against fluctuations in maternal energy balance, making the fetus in effect a “nearly perfect parasite.” This buffering would appear to be a reasonable adaptive response given the high risk of morbidity and mortality associated (...) with low birth weight. However, a life-history approach leads to the prediction that maternal investment strategies in pregnancy should be geared toward maximizing lifetime reproductive success rather than simply the success of the current pregnancy, and by extension that maternal investment strategies should vary with reproductive value. The physiology of human pregnancy in fact appears to include a number of mechanisms that protect maternal energy resources from diversion to the fetus and preserve them for future reproductive events. These mechanisms include adjustment of blood flow to the uterus and perhaps minor adjustments in gestation length, although evidence for the latter is scant. Suggestions are made for ways of investigating these maternal options. (shrink)

Two conundrums puzzle COVID‐19 investigators: 1) morbidity and mortality is rare among infants and young children and 2) rates of morbidity and mortality exhibit large variances across nations, locales, and even within cities. It is found that the higher the rate of pneumococcal vaccination in a nation (or city) the lower the COVID‐19 morbidity and mortality. Vaccination rates with Bacillus Calmette–Guerin, poliovirus, and other vaccines do not correlate with COVID‐19 risks, nor do COVID‐19 case or death rates (...) correlate with number of people in the population with diabetes, obesity, or adults over 65. Infant protection may be due to maternal antibodies and antiviral proteins in milk such as lactoferrin that are known to protect against coronavirus infections. Subsequent protection might then be conferred (and correlate with) rates of Haemophilus influenzae type B (Hib) (universal in infants) and pneumococcal vaccination, the latter varying widely by geography among infants, at‐risk adults, and the elderly. Also see the video abstract here https://youtu.be/GODBYRbPL00. (shrink)

SummaryHuman height is a heritable trait that is known to be influenced by environmental factors and general standard of living. Individual and population stature is correlated with health, education and economic achievement. Strong sexual selection pressures for stature have been observed in multiple diverse populations, however; there is significant global variance in gender equality and prohibitions on female mate selection. This paper explores the contribution of general standard of living and gender inequality to the variance in global female population heights. (...) Female population heights of 96 nations were culled from previously published sources and public access databases. Factor analysis with United Nations international data on education rates, life expectancy, incomes, maternal and childhood mortality rates, ratios of gender participation in education and politics, the Human Development Index and the Gender Inequality Index was run. Results indicate that population heights vary more closely with gender inequality than with population health, income or education. (shrink)

SummaryThis study examines local heterogeneity in the aptitude of Sardinian mothers towards late reproduction, and explores its temporal persistence and association with both post-reproductive longevity and propensity to consanguineous marriage. Data on women's fertility from 1961 and birth records for 1980–1996 from Vital Statistics were analysed by means of the following indicators: the incidence of old mothers at last childbirth, female mortality at 80 years of age and over and the proportion of consanguineous marriages. A variable kernel-smoothing method was (...) used to create interpretable representations of the true spatial structure of the indicators, and to highlight areas of higher than expected intensity. In particular, an area of reproductive and post-reproductive longevity was identified where the traits combine with a higher tendency to relatedness. Intriguingly, this area corresponds approximately to the geographically and historically well defined central-eastern zone, which was the refuge of Sardinians during past invasions, and overlaps the Ogliastra region, which has been widely studied for its genetic homogeneity. (shrink)

Kant's contribution to modern Protestant theology is as unmistakable as it is controversial. The authors of this volume are investigating a new perspective on the work of theology and the effects of Kant's philosophy of religion concentrated on biblical hermeneutics and dogmatic theology.

Cet article a pour objectif de montrer l’importance de la réception de la théologie politique de J.B. Metz auprès de certains théologiens soucieux de la dimension politique de la foi chrétienne. L’étude présente les réactions immédiates au projet théologique de Metz pour ensuite se focaliser sur des théologiens contemporains. Premièrement, on trouve J. Milbank, qui apprécie la pensée de Metz en la confrontant à son programme de Radical Orthodoxy. Deuxièmement, on rencontre H.-J. Gagey et J.-L. Souletie, qui évaluent la force (...) politique de la théologie de Metz. Enfin, on découvre la façon dont L. Boeve reprend de façon personnelle certains aspects de la pensée du théologien allemand. Pour terminer, l’article propose une réflexion synthétique et critique sur cette réception, avec le souci de montrer la pertinence de la théologie politique de Metz et sa capacité à stimuler la réflexion sur le rapport foi et société. (shrink)