Guinea-Bissau: maternal mortality assessment.

With more than 40% of all female deaths attributable to pregnancy, delivery, and the puerperium period, the study established a maternal mortality ratio of 914 deaths per 100,000 live births. The principal risk factors for dying from pregnancy-related causes are: no attendance at antenatal care, too great a distance between the home and the nearest hospital facility, home delivery, belonging to specific ethnic/religious groups, and delivery assistance from family members and TBAs. The health policy implications to improve this situation are: increased coverage with appropriate services, increased numbers of rural midwives, in-service training of existing staff in maternity issues and problems, culture-specific educational approaches using the existing value system, educational campaigns to discourage harmful practices and behaviour, continued educational efforts to upgrade the knowledge of TBAs, and a culturally sensitive integration of TBAs into the government programmes.