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MEDIA CENTER Researchers Tackle Maternal Mortality in Dominican Republic NEW YORK (28 June 2002) — In the Dominican Republic, the majority of women have access to prenatal care and give birth in hospitals or health care clinics, conditions that bode well for maternal health. Why then, researchers asked, is the country's maternal mortality rate so high, estimated at as many as 229 deaths per 100,000 live births? After forming an assessment team and analyzing the country's national reproductive health care program, Population Council researchers working with colleagues in the Dominican Republic have an answer: lack of quality of care in the maternity wards where the majority of births occur. According to the researchers' recently published report, complicated births were not given the attention they deserved, and normal cases were overmedicalized. In many of the larger hospitals, overcrowded conditions and lack of adequately trained attendants contributed to a higher rate of maternal death. The report, "Strategic Assessment of Reproductive Health in the Dominican Republic," was sponsored by the US Agency for International Development (USAID), the Population Council, and the Dominican Republic's Ministry of Health and Social Welfare (SESPAS). The study, begun in October 2001, was designed to identify strengths; prioritize problems; and work with community, governmental, and nongovernmental stakeholders to improve reproductive health care. The study revealed that lower-level regional institutions, while often clean and well managed, were not prepared to handle high-risk pregnancies; any complicated deliveries requiring anesthesia or blood transfusions were referred to higher-level institutions. Yet the national program lacked a formal plan to transport women from lower- to higher-level facilities. While a few institutions used ambulances, in most cases women were forced to rely on public transportation or private vehicles. Because physicians in the lower-level regional institutions often failed to appear for work, untrained nurses in these hospitals would either send all women on to the referral hospitals, or attempt to conduct deliveries themselves, receiving only telephone instructions from physicians. At the larger hospitals, researchers discovered crowded conditions and a lack of adequately trained attendants. For example, in one hour of observation at one of these higher-level hospitals, the research team observed 12 births. During that time the most experienced person in the delivery ward was a first-year resident with five months of service. The other eight providers were interns, medical students, and nurses. "In promoting safe motherhood initiatives, the conventional wisdom is that if you get the women to the hospital, you will save lives," noted the study's lead investigator, Suellen Miller, Population Council senior consulting associate. "In the Dominican Republic, women were doing what they were supposed to be doing to ensure a safe birth: they were going to hospitals for delivery. The physicians were the ones who failed to follow the established norms for quality care, resulting in a high rate of maternal death." The findings have prompted Dominican health officials to suspend offending physicians and implement other measures to decrease maternal mortality; international donors are also ready to fund innovative proposals for improving reproductive health.
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