Liljestrand Jerker, Pathmanathan Indra
Department of Community Medicine, Lund University, Malmö University Hospital, Sweden.
J Public Health Policy. 2004;25(3-4):299-314. doi: 10.1057/palgrave.jphp.3190030.
Developing countries are floundering in their efforts to meet the Millennium Development Goal of reducing maternal mortality by 75% by 2015. Two issues are being debated. Is it doable within this time frame? And is it affordable? Malaysia and Sri Lanka have in the past 50 years repeatedly halved their maternal mortality ratio (MMR) every 7-10 years to reduce MMR from over 500 to below 50. Experience from four other developing countries--Bolivia, Yunan in China, Egypt, and Jamaica-confirms that each was able to halve MMR in less than 10 years beginning from levels of 200-300. Malaysia and Sri Lanka, invested modestly (but wisely)--less than 0.4% of GDP--on maternal health throughout the period of decline, although the large majority of women depended on publicly funded maternal health care. Analysis of their experience suggests that provision of access to and removal of barriers for the use of skilled birth attendance has been the key. This included professionalization of midwifery and phasing out of traditional birth attendants; monitoring births and maternal deaths and use of such information for high profile advocacy on the importance of reducing maternal death; and addressing critical gaps in the health system; and reducing disparities between different groups through special attention to the poor and disadvantaged populations.
发展中国家在努力实现到2015年将孕产妇死亡率降低75%这一千年发展目标的过程中举步维艰。目前有两个问题备受争议。在这个时间框架内是否可行？以及是否负担得起？马来西亚和斯里兰卡在过去50年里每隔7至10年就将孕产妇死亡率（MMR）减半，从而使孕产妇死亡率从超过500降至50以下。来自其他四个发展中国家——玻利维亚、中国云南、埃及和牙买加——的经验证实，从200 - 300的水平开始，每个国家都能在不到10年的时间里将孕产妇死亡率减半。马来西亚和斯里兰卡在孕产妇死亡率下降的整个期间，对孕产妇健康投入不多（但很明智）——不到国内生产总值的0.4%，尽管绝大多数妇女依赖公共资助的孕产妇保健服务。对它们经验的分析表明，提供获得熟练助产服务的途径并消除使用这类服务的障碍是关键。这包括助产士专业化以及逐步淘汰传统接生员；监测分娩和孕产妇死亡情况，并利用此类信息进行关于降低孕产妇死亡重要性的高调宣传；解决卫生系统中的关键差距；以及通过特别关注贫困和弱势群体来减少不同群体之间的差距。
