Mexico Verbal Autopsy Study
Because many women in the developing world deliver at home and medical services are scarce, there is no precise or accurate understanding of the medical and social causes of maternal mortality. In Mexico, the Council conducted a large "verbal autopsy" study to identify the causes of maternal mortality and morbidity.

The Population Council's study demonstrated that the verbal autopsy methodology has inherent limitations in identifying the medical causes of death and reconfirms the knowledge that mortality among poor women with little access to medical care is substantially higher than that among wealthier women who have better access to good care, institutional delivery, and postpartum care.

Vietnam Postpartum Infection Study
Infection-related maternal mortality may generally be underestimated in developing countries due to poor diagnosis, particularly when fewer than 30 percent of women seek or receive postpartum care or medical follow-up. Currently 15 percent of global maternal mortality is attributed to infection, however infection may account for some portion of the 25 percent attributed to hemorrhage, the 13 percent to unsafe abortion and the 27 percent of maternal mortality attributed to other direct and indirect causes.

Preventing or treating infection alone may have a substantial impact on reducing maternal mortality in developing countries. The Population Council conducted a six week medical follow-up of consenting women delivering in Vietnam to determine the incidence of postpartum infection and to judge the extent to which the incidence of postpartum infection is underestimated. This study indicates that the incidence of postpartum infection is considerably higher than expected even in this environment where postpartum administration of antibiotics is almost universal.

Postpartum Care in Pakistan
A service vacuum exists throughout the postpartum period in developing countries. Studies supported by the Council are underway in several countries to learn about all aspects of the postpartum period, including women's perceptions and needs, providers' knowledge and attitudes, and service delivery systems and practices. As part of these efforts, interventions are evaluated and postpartum service models that offer medical and appropriate contraceptive choices to postpartum women, including explicit consideration of the contraceptive effects of breastfeeding and lactational amenorrhea, are developed.

Lack of spousal support may contribute to not seeking treatment for postpartum morbidity. As part of the Council's program, an assessment of postpartum care was conducted in low socioeconomic settlements of Pakistan. Although most women attend antenatal care, and half have skilled attendance at delivery, very few women attend the recommended six weekly postpartum visit, even though more than half believe they experience some postpartum morbidity. In this setting, women generally seek advice from elders and traditional birth attendants. Caring for the new mother and her baby has traditionally been a "women's" domain, although spousal support is evident (one-fourth of the women reported that husbands assisted in changing babies nappies [diapers], and about twenty percent aided in household chores). Still, spousal opposition was the main reason for not opting to delay the next pregnancy and future contraceptive use was less likely if spousal support was not provided.

See Also

• Ebert Program Safe Motherhood Resources

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