McCarthy J, Maine D
Center for Population and Family Health, Columbia University, New York, NY 10032.
Stud Fam Plann. 1992 Jan-Feb;23(1):23-33.
Hundreds of thousands of women in developing countries die each year from complications of pregnancy, attempted abortion, and childbirth. This article presents a comprehensive and integrated framework for analyzing the cultural, social, economic, behavioral, and biological factors that influence maternal mortality. The development of a comprehensive framework was carried out by reviewing the widely accepted frameworks that have been developed for fertility and child survival, and by reviewing the existing literature on maternal mortality, including the results of research studies and accounts of intervention programs. The principal result of this exercise is the framework itself. One of the main conclusions is that all determinants of maternal mortality (and, hence, all efforts to reduce maternal mortality) must operate through a sequence of only three intermediate outcomes. These efforts must either (1) reduce the likelihood that a woman will become pregnant; (2) reduce the likelihood that a pregnant woman will experience a serious complication of pregnancy or childbirth; or (3) improve the outcomes for women with complications. Several types of interventions are most likely to have substantial and immediate effects on maternal mortality, including family planning programs to prevent pregnancies, safe abortion services to reduce the incidence of complications, and improvements in labor and delivery services to increase the survival of women who do experience complications.
发展中国家每年有数十万妇女死于妊娠、堕胎未遂及分娩并发症。本文提出了一个全面综合的框架，用于分析影响孕产妇死亡率的文化、社会、经济、行为及生物学因素。通过回顾为生育率和儿童生存所制定的广泛认可的框架，以及回顾关于孕产妇死亡率的现有文献，包括研究结果和干预项目报告，从而构建了这一全面框架。这项工作的主要成果就是该框架本身。其中一个主要结论是，孕产妇死亡率的所有决定因素（因此，所有降低孕产妇死亡率的努力）都必须通过仅三个中间结果的序列来发挥作用。这些努力必须要么（1）降低妇女怀孕的可能性；（2）降低孕妇经历严重妊娠或分娩并发症的可能性；要么（3）改善有并发症妇女的结局。几种类型的干预措施最有可能对孕产妇死亡率产生重大且直接的影响，包括预防怀孕的计划生育项目、减少并发症发生率的安全堕胎服务，以及改善分娩服务以提高出现并发症妇女的存活率。
