Gertler P, Rahman O, Feifer C, Ashley D
Rand Corporation, Santa Monica CA 90407.
Soc Sci Med. 1993 Jul;37(2):199-211. doi: 10.1016/0277-9536(93)90455-d.
Detailed nationally representative population level data were used to investigate the pre-natal care and delivery experiences of pregnant women in Jamaica. The results of this study show that: (a) demographic criteria (particularly first births) and self-reported clinical pregnancy complications are valid predictors of deleterious maternal health outcomes and can be used to stratify mothers into risk groups. (b) There appears to be a significant problem of under and inappropriate utilization of pre-natal care services by all women and in particular by demographically 'high risk' women, i.e. young, first time mothers. Significant proportions of the latter group report either no pre-natal care visits at all or visits which are later than the first trimester. The problems of delayed initiation of pre-natal care are specially exacerbated for poor, teenage mothers who happen to be living in the Kingston Metropolitan Area. (c) In terms of the content and quality of pre-natal care services the message is somewhat mixed. On the positive side the pre-natal care system is doing a moderately satisfactory job with regard to diagnostic tests and educational advice. On the negative side however, the fact that once women enter the health care system they all receive the same moderately adequate care (in terms of diagnostic evaluations and educational advice) with no attempt to focus particular attention on high risk mothers is troublesome. (d) With regard to appropriate delivery venues for pregnant women, pre-natal care visits do not appear to significantly influence the choice of delivery venues. Moreover, rich urban women are much more likely to deliver in a hospital than their rural peers. In conclusion, the study discusses the social and behavioral context of these results, addresses the policy implications and makes some recommendations to improve maternal health services.
利用具有全国代表性的详细人口水平数据，对牙买加孕妇的产前护理和分娩经历进行了调查。这项研究的结果表明：(a) 人口统计学标准（尤其是初产情况）和自我报告的临床妊娠并发症是孕产妇不良健康结局的有效预测指标，可用于将母亲分为不同风险组。(b) 所有女性，尤其是人口统计学上 “高风险” 的女性，即年轻的初产妇，在产前护理服务的利用不足和使用不当方面似乎存在重大问题。后一组中有相当大比例的人报告根本没有进行产前检查，或者检查时间晚于孕早期。对于居住在金斯敦都会区的贫困少女母亲来说，产前护理延迟开始的问题尤为严重。(c) 在产前护理服务的内容和质量方面，情况喜忧参半。从积极的方面来看，产前护理系统在诊断测试和教育建议方面做得还算令人满意。然而，从消极的方面来看，一旦女性进入医疗保健系统，她们都接受同样适度充分的护理（在诊断评估和教育建议方面），而没有尝试特别关注高风险母亲，这一点令人担忧。(d) 关于孕妇合适的分娩地点，产前检查似乎并没有显著影响分娩地点的选择。此外，富裕的城市女性比农村同龄人更有可能在医院分娩。总之，该研究讨论了这些结果的社会和行为背景，阐述了政策影响，并提出了一些改善孕产妇健康服务的建议。
