Walsh J A, Measham A R, Feifer C N, Gertler P J
Department of Population and International Health, Harvard School of Public Health, Boston, MA 02115.
Int J Health Plann Manage. 1994 Apr-Jun;9(2):131-49. doi: 10.1002/hpm.4740090203.
Each year, an estimated half million women die from complications related to child birth either during pregnancy, delivery or within 42 days afterwards. When pregnant women have complications, their infants are at greater risk of becoming ill, permanently disabled or dying. For every maternal death, there are at least 20 infant deaths: stillbirths, neonatal or postneonatal deaths. Altogether, an estimated 7 million infants each year die perinatally (stillborn or deaths within the first week of life). Low cost, feasible, and effective intervention strategies include: a) improved family planning and abortion services; b) obstetric care at delivery; and, c) prenatal services. Two hypothetical populations of one million (a low mortality and a high mortality country) are used to illustrate maternal and perinatal program strategies and priorities. In countries with high fertility, major reductions in maternal and infant deaths result both from reductions in the number of pregnancies through family planning and from improved obstetric care. Where fertility is already low, reductions result almost entirely from improved obstetric and prenatal care. The investments required are relatively low, while the potential gains are great. The cost to avert each death in a high mortality population is estimated between $800 and $1,500 or as low as $0.50 per capita per year. The priorities for programs targeting maternal and perinatal health depend on demographic, ecologic and economic factors, and should include the promotion of good health, not merely the avoidance of death. More operational research is required on various aspects of maternal and perinatal health; in particular, on the cost-effectiveness of different service components.
据估计，每年有50万妇女死于与分娩相关的并发症，这些并发症发生在孕期、分娩期间或产后42天内。孕妇出现并发症时，其婴儿患病、永久致残或死亡的风险会更高。每发生一例孕产妇死亡，至少会有20例婴儿死亡，包括死产、新生儿死亡或新生儿期后死亡。每年总计约有700万婴儿在围产期死亡（死产或出生后第一周内死亡）。低成本、可行且有效的干预策略包括：a）改善计划生育和堕胎服务；b）分娩时的产科护理；c）产前服务。以两个假设的百万人口群体（一个低死亡率国家和一个高死亡率国家）为例，说明孕产妇和围产期项目的策略及重点。在生育率高的国家，孕产妇和婴儿死亡人数大幅减少，这既得益于通过计划生育减少怀孕次数，也得益于改善产科护理。在生育率已经较低的地方，死亡人数减少几乎完全归功于产科和产前护理的改善。所需投资相对较低，而潜在收益巨大。在高死亡率人群中，避免一例死亡的成本估计在800美元至1500美元之间，或低至人均每年0.50美元。针对孕产妇和围产期健康的项目重点取决于人口、生态和经济因素，应包括促进健康，而不仅仅是避免死亡。需要对孕产妇和围产期健康的各个方面进行更多的运筹学研究，特别是不同服务组成部分的成本效益。
