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Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era

Kendall, Tamil; Langer, Ana
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.28%
Effective interventions to promote maternal health and address obstetric complications exist, however 800 women die every day during pregnancy and childbirth from largely preventable causes and more than 90 % of these deaths occur in low and middle income countries (LMIC). In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health. The vision of maternal health articulated was comprehensive and priorities for knowledge generation encompassed improving the availability, accessibility, acceptability, and quality of institutional labor and delivery services and other effective interventions, such as contraception and safe abortion services. Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time. Researchers also emphasized the development of tools to measure quality of care and promote ongoing quality improvement at the facility, district, and national level. Knowledge generation to improve distribution and retention of healthcare workers...

"...and then she died" : Indonesia Maternal Health Assessment

World Bank
Fonte: World Bank Publicador: World Bank
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66.32%
Maternal health remains one of the top priorities of the Government of Indonesia (GoI) and the Ministry of Health (MoH) because reductions in maternal mortality have been slows. The current Maternal Mortality Ratio (MMR) for Indonesia is 228 but with existing programs and interventions the government does not believe it will be able to achieve its stated millennium development goal of 102 maternal deaths per 100,000 live births by 2015. There are positive trends in an increased use of skilled birth attendants, almost universal access to some level of antenatal care and continued use of family planning but these are not enough to stem the tide of maternal death. Interventions by the skilled birth attendants in many cases are not in line with existing standards and prove to be ineffective in trying to address the emergence of complications. Antenatal care is important, but it is not where gains in decreased mortality will be obtained. The continued use of traditional birth attendants (TBA) and delivering at home are contributory factors to maternal mortality in Indonesia. In collecting data from verbal autopsies in three districts...

Accelerating Progress towards Achieving the MDG to Improve Maternal Health : A Collection of Promising Approaches

Nanda, Geeta; Switlick, Kimberly; Lule, Elizabeth
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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66.28%
One of the Millennium Development Goals (MDG) is to improve maternal health, with the target of reducing maternal mortality by three-quarters between 1990 and 2015. In an effort to accelerate progress towards achieving this MDG, this paper brings together high-quality information on a wide range of promising approaches that aim to improve maternal health outcomes. These global promising approaches, based on field research and practice by experienced organizations working in this arena, can serve as a useful starting point in the process to improve current maternal health programming. This paper will be useful for World Bank staff when assisting client countries in developing their National Poverty Reduction Strategy Papers (PRSPs) and costing health sector plans. Moreover, the paper provides Bank staff with substantive evidence to share with governments on how best to prioritize and implement maternal health programs, and scale up efforts to achieve progress. Although primarily intended for use by Bank staff, we hope this guide will also be useful to governments...

Investing in Maternal Health : Learning from Malaysia and Sri Lanka

Pathmanathan, Indra; Liljestrand, Jerker; Martins, Jo. M.; Rajapaksa, Lalini C.; Lissner, Craig; de Silva, Amala; Selvaraju, Swarna; Singh, Prabha Joginder
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
EN_US
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66.33%
This study provides the most comprehensive and detailed analysis available on factors behind the decline in maternal mortality in Malaysia and Sri Lanka in the past 50 to 60 years and the magnitude of health system expenditures on maternal health. The main findings are that a modest investment in maternal health services, combined with other poverty reduction measures leads to a fairly rapid decline in the maternal mortality ratio (MMR), defined as the number of maternal deaths per 100,000 live births. The strategies of Malaysia and Sri Lanka changed over time, from an initial emphasis on expanding the provision of services, especially in underserved areas, to increasing utilization and, finally, to emphasizing the improvement of quality. Removing financial barriers to maternal care for clients was an important step in both countries. Professional midwives constitute the backbone of maternal care in Malaysia and Sri Lanka. The MMR reduction in developing countries is feasible with modest public expenditures when appropriate policies are adopted...

Pragmatic indicators for remote Aboriginal maternal and infant health care: why it matters and where to start

Steenkamp, M.; Bar-Zeev, S.; Rumbold, A.; Kildea, S.
Fonte: Public Health Assoc Australia Inc Publicador: Public Health Assoc Australia Inc
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
66.21%
Objective: There are challenges in delivering maternal and infant health (MIH) care to remote Northern Territory (NT) communities. These include fragmented care with birthing in regional hospitals resulting in cultural and geographical dislocation for Aboriginal women. Many NT initiatives are aimed at improving care. Indicators for evaluating these for remote Aboriginal mothers and infants need to be clearer. We reviewed existing indicators to inform a set of pragmatic indicators for reporting improvement in remote MIH care. Methods: Scientific databases and grey literature (organisational websites and Google Scholar) were searched using the terms ‘Aboriginal/maternal/infant/remote health/monitoring performance’. Key stakeholders identified omitted indicators sets. Relevant sets were reviewed and organised by indicator type, stage of patient journey, topic and theme. Results: Forty-two indicators sets were found. Seven focused on Aboriginal health, 23 on reproductive/maternal health, eight on child/infant health and four on other aspects, e.g. remote health. We identified more than 1,000 individual indicators. Of these, 656 were relevant for our purpose and were subsequently organised into 300 topics and 16 themes for antenatal...

National female literacy, individual socio-economic status, and maternal health care use in sub-Saharan Africa

McTavish, S.; Moore, S.; Harper, S.; Lynch, J.
Fonte: Pergamon-Elsevier Science Ltd Publicador: Pergamon-Elsevier Science Ltd
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
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The United Nations Millennium Development Goals have identified improving women's access to maternal health care as a key target in reducing maternal mortality in sub-Saharan Africa (sSA). Although individual factors such as income and urban residence can affect maternal health care use, little is known about national-level factors associated with use. Yet, such knowledge may highlight the importance of global and national policies in improving use. This study examines the importance of national female literacy on women's maternal health care use in continental sSA. Data that come from the 2002-2003 World Health Survey. Multilevel logistic regression was used to examine the association between national female literacy and individual's non-use of maternal health care, while adjusting for individual-level factors and national economic development. Analyses also assessed effect modification of the association between income and non-use by female literacy. Effect modification was evaluated with the likelihood ratio test (G(2)). We found that within countries, individual age, education, urban residence and household income were associated with lack of maternal health care. National female literacy modified the association of household income with lack of maternal health care use. The strength of the association between income and lack of maternal health care was weaker in countries with higher female literacy. We conclude therefore that higher national levels of female literacy may reduce income-related inequalities in use through a range of possible mechanisms...

Improving Maternal Health and Sexual and Reproductive Health - Australia's Responsibility -

Hogan, Laura
Fonte: Universidade Nacional da Austrália Publicador: Universidade Nacional da Austrália
Tipo: Relatório
Relevância na Pesquisa
66.2%
The Millennium Development Goals, particularly the eradication of extreme poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And that means stronger efforts to promote women's rights, and greater investment in education and health, including reproductive health and family planning. United Nations Secretary-General, Kofi Annan (United Nations Economic and Social Commission for Asia and the Pacific 2002) Poor sexual and reproductive health contributes significantly to poverty and the ability to participate in socio-economic development. It is the major cause of death, disability and suffering among women globally (World Health Organisation 2009). It is the poorest and least educated women who have the highest risk of death during pregnancy or childbirth (WHO 201 0). Targeted investments in reproductive health can have dramatic benefits for the economic and social health of communities. Recognition of the importance of maternal health has gained international momentum, particularly following the International Conference on Population and Development (ICPD) and the inclusion of Maternal Health and Sexual Reproductive Health (MH&SRH) in the Millennium Development Goals (MDGs)...

Utilization of maternal health-care services in Peru: the role of women's education

Elo, Irma T
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University
Tipo: Artigo de Revista Científica Formato: 66206 bytes; application/pdf
EN_AU
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This article explores the hypothesis that formal education of women influences the use of maternal health-care services in Peru, net of the mother’s childhood place of residence, household socioeconomic status and access to health-care services. The findings are consistent with the hypothesis; both cross-sectional and fixed-effects logit models yield quantitatively important and statistically reliable estimates of the positive effect of maternal schooling on the use of prenatal care and delivery assistance. In addition, large differentials were found in the utilization of maternal health-care services by place of residence, suggesting that much greater efforts on the part of the government are required if modern maternal health-care services are to reach women in rural areas.; yes

Cultural Resources and Maternal Health in Mali; Ressources culturelles et sante maternelle au Mali

Clemmons, Lydia; Coulibaly, Yaya
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
ENGLISH
Relevância na Pesquisa
66.23%
In spite of the cultural, traditional taboo on the subject of pregnancy in most African households, the success of the Africare's Child Survival Project in Mali, documents the increased communication, and behavior changes in health seeking during pregnancy. Africare is a US-based private, voluntary organization, working in community development, and through its efforts, constructed a maternity ward in the country, supported by government health professionals. The note describes the research work underwent by Africare to identify both resources, and obstacles related to to improved maternal health, and care-seeking. Findings revealed that both women, and men were well aware of the risks associated with pregnancy, enhanced by cultural traits which places a strong value on supportive husbands during pregnancy. However, one of the most striking cultural obstacles to women's maternal health care, was the absence of discussions on the subject, due entirely to the taboo issue about sexual relations, and pregnancy. Following a pilot maternal health campaign - based on cultural...

Maternal Health, Child Health and Nutrition in Lao PDR : Evidence from a Household Survey in Six Central and Southern Provinces

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Health Study; Economic & Sector Work
ENGLISH; EN_US
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66.3%
Despite being on-track on the child- and maternal-health Millennium Development Goals (MDGs), Lao PDR continues to have some of the worst maternal and child health (MCH) and nutrition outcome indicators, both globally as well as in the East Asia and Pacific (EAP) region. This report presents results from a household, village, and facility survey on Maternal and Child Health (MCH) and nutrition in mostly rural areas of six central and southern provinces of Lao People's Democratic Republic (PDR). The information in this report localizes MCH and nutrition-related information that are typical for sampled catchment areas of selected health centers in six central and southern provinces of the country. In addition, the report summarizes data on service availability and readiness of health centers in terms of their ability to provide key MCH & nutrition-related services. The results from this survey thus shed light on what it would take to attain the health-related MDGs. In order to improve the level and equity of maternal and child health indicators...

Achieving the Millennium Development Goal of Improving Maternal Health : Determinants, Interventions and Challenges

Lule, Elizabeth; Ramana, G.N.V.; Ooman, Nandini; Epp, Joanne; Huntington, Dale; Rosen, James E.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
66.29%
This paper summarizes the importance of improving maternal and reproductive health, the progress made to date and lessons learned, and the major challenges confronting programs today. The paper highlights the progress that some countries, including very poor ones, have made in reducing maternal mortality, but cautions that progress in many countries remains slow. Relying on evidence from the most recent research and survey information, the paper also analyzes the key determinants and evidence on effective interventions for attaining the maternal health MDG. The paper finds that key interventions to improve maternal and reproductive health and reduce maternal mortality include the following mutually reinforcing strategies: (a) mobilizing political commitment and fostering an enabling policy environment; (b) investing in social and economic development such as female education, poverty reduction, and improvements in women's status; (c) providing family planning services; (d) ensuring quality antenatal care...

Universal Maternal Health Coverage? Assessing the Readiness of Public Health Facilities to Provide Maternal Health Care in Indonesia

World Bank; Indonesia National Institute of Research and Development
Fonte: World Bank, Jakarta Publicador: World Bank, Jakarta
Tipo: Economic & Sector Work :: Other Health Study
ENGLISH; EN_US
Relevância na Pesquisa
66.35%
Over the period 2011-2013, Indonesia had universal maternal health coverage for its population. Facility-based deliveries, however, remain relatively low: only about 63 percent of all deliveries occurred at a health facility in Indonesia. Recent progress notwithstanding, and despite the relatively high utilization rates for most key maternal health services, the level of maternal mortality remains high in Indonesia, especially in provinces such as West Papua, North Maluku, Papua, Gorontalo, West Sulawesi, Maluku, and South Kalimantan. This policy paper assesses the supply-side readiness of Indonesia s public health facilities in providing key maternal health services such as antenatal care (ANC) as well as basic and comprehensive emergency obstetric care. The focus in the paper is on assessing to what extent Indonesia's universal maternal health coverage is real. Ensuring the supply-side readiness of Indonesia's health system, incorporating lessons from the past experiences of implementing universal maternal health coverage under the different social health insurance programs...

Trends in Maternal Mortality : 1990 to 2013

WHO; UNICEF; UNFPA; World Bank; United Nations Population Division
Fonte: Geneva: World Health Organization Publicador: Geneva: World Health Organization
Tipo: Publications & Research :: Publication; Publications & Research
ENGLISH; EN_US
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A number of initiatives that commenced in recent years are geared towards achievement of the fifth millennium development goal (MDG 5: improving maternal health), most notably the launch of the global strategy for women's and children's health in 2010 by the United Nations (UN) Secretary-General. Measuring the MDG 5 target of reducing the maternal mortality ratio (MMR) by three quarters between 1990 and 2015 remains a challenge. Accordingly, the maternal mortality estimation inter-agency group (MMEIG), comprising the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), the United Nations Population Division (UNPD), and the World Bank, together with a team at the National University of Singapore and University of California at Berkeley, United States of America, have been working together to generate internationally comparable MMR estimates. The estimates for 2013 presented in this report are the seventh in a series of analyses by the MMEIG to examine the global extent of maternal mortality. Consultations with countries were carried out following the development of the MMR estimates. The purposes of the consultations were: to give countries the opportunity to review the country estimates...

Materno-infantilism, feminism and maternal health policy in Brazil

Diniz, Carmen Simone Grilo
Fonte: ELSEVIER SCIENCE BV; AMSTERDAM Publicador: ELSEVIER SCIENCE BV; AMSTERDAM
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
66.19%
In the last days of 2011, President of Brazil Dilma Rousseff issued a provisional measure (or draft law) entitled "National Surveillance and Monitoring Registration System for the Prevention of Maternal Mortality" (MP 557), as part of a new maternal health programme. It was supposed to address the pressing issue of maternal morbidity and mortality in Brazil, but instead it caused an explosive controversy because it used terms such as nascituro (unborn child) and proposed the compulsory registration of every pregnancy. After intense protests by feminist and human rights groups that this law was unconstitutional, violated women's right to privacy and threatened our already limited reproductive rights, the measure was revised in January 2012, omitting "the unborn child" but not the mandatory registration of pregnancy. Unfortunately, neither version of the draft law addresses the two main problems with maternal health in Brazil: the over-medicalisation of childbirth and its adverse effects, and the need for safe, legal abortion. The content of this measure itself reflects the conflictive nature of public policies on reproductive health in Brazil and how they are shaped by close links between different levels of government and political parties...

The Gambia Impact Evaluation Baseline Report; Maternal Health and Nutrition

World Bank Group
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Brief; Publications & Research :: Brief; Publications & Research
EN_US
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The Government of The Gambia is implementing the Maternal and Child Nutrition and Health Results Project (MCNHRP) to increase the utilization of community nutrition and primary maternal and child health services. In collaboration with the Government, the World Bank is conducting an impact evaluation (IE) to assess the impact of the project on key aspects of maternal and child nutrition and health. The baseline survey for the MCNHRP IE took place between November 2014 and February 2015. It collected both quantitative and qualitative data and covered three regions: Central River Region (CRR), North Bank Region West (NBR-W) and Upper River Region (URR). Its purpose was to establish a baseline against which project performance will be assessed in the future. This technical brief specifically summarizes the findings of the baseline report related to maternal health and nutrition.

Towards Comprehensive Women's Healthcare in Sub-Saharan Africa: Addressing Intersections Between HIV, Reproductive and Maternal Health

Kendall, Tamil; Bärnighausen, Till; Fawzi, Wafaie W.; Langer, Ana
Fonte: JAIDS Journal of Acquired Immune Deficiency Syndromes Publicador: JAIDS Journal of Acquired Immune Deficiency Syndromes
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.21%
Abstract: This themed supplement to JAIDS: Journal of Acquired Immune Deficiency Syndromes focuses on the critical intersections between HIV, reproductive, and maternal health services in the health systems of sub-Saharan Africa. The epidemiology of HIV among women of reproductive age on the sub-continent demands a holistic conceptualization and comprehensive approaches to ensure that HIV, reproductive, and maternal health are optimally addressed. Yet, in many instances, the national and global responses to these health issues remain siloed. Women's health needs and new global and national guidelines for HIV treatment raise important policy, programmatic, and operational questions regarding service integration, scale-up, and health systems functioning. In June 2013, the Maternal Health Task Force at the Harvard School of Public Health, the United States Agency for International Development, and the United States Centers for Disease Control and Prevention convened an international technical meeting of researchers, policymakers, and practitioners to discuss the existing evidence base about the interconnections between HIV, reproductive, and maternal health and identify the most important knowledge gaps and research priorities. The articles in this special issue deepen and expand on those discussions by (1) providing empirical evidence about challenges...

National maternal mortality ratio in Egypt halved between 1992-93 and 2000

Campbell,Oona; Gipson,Reginald; Issa,Adel Hakim; Matta,Nahed; El Deeb,Bothina; El Mohandes,Ayman; Alwen,Anna; Mansour,Esmat
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2005 EN
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66.22%
Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from a representative sample of health bureaus covering all of Egypt, except for five frontier governorates which were covered only by the later survey, using the vital registration forms. The numbers of maternal deaths were determined and interviews conducted. The medical causes of death and avoidable factors were determined. Results showed that the maternal mortality ratio (MMR) had dropped by 52% within that period (from 174 to 84/100 000 live births). The National Maternal Mortality Survey in 1992-93 (NMMS) revealed that the metropolitan areas and Upper Egypt had a higher MMR than Lower Egypt. In response to these results, the Egyptian Ministry of Health and Population (MOHP) intensified the efforts of its Safe Motherhood programmes in Upper Egypt with the result that the regional situation had reversed in 2000. Consideration of the intermediate and outcome indicators suggests that the greatest effect of maternal health interventions was on the death-related avoidable factors "substandard care by health providers" and "delays in recognizing problems or seeking medical care". The enormous improvements in these areas are certainly due in part to extensive training...

Utilization of maternal health care services in the department of Matagalpa, Nicaragua

Lubbock,Lindsey Ann; Stephenson,Rob B.
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2008 EN
Relevância na Pesquisa
66.22%
OBJECTIVES: To better understand the individual and community factors and perceptions that influence women's health care-seeking behaviors during pregnancy in order to increase women's utilization of maternal health services. METHODS: This study investigates the logistical and sociocultural barriers influencing women's utilization of maternal health services through 37 semi-structured in-depth interviews with women from the department of Matagalpa, Nicaragua. RESULTS: Results reveal that delays in seeking health care during pregnancy are influenced not only by poor access to care and economic barriers but also by individual and community knowledge and acceptance of maternal health services. Partner support, previous maternal health care experiences, and the degree of communication with other women and health workers affect women's decisions to seek care. CONLUSIONS: Evidence suggests that in order to improve maternal health outcomes in this region, interventions must be targeted at a hierarchy of levels: individual, household, and community.

An adequacy evaluation of a maternal health intervention in rural Honduras: the impact of engagement of men and empowerment of women

Berti,Peter R.; Sohani,Salim; Costa,Edith da; Klaas,Naomi; Amendola,Luis; Duron,Joel
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2015 EN
Relevância na Pesquisa
66.2%
Objective. To determine the impact that a 6-year maternal and child health project in rural Honduras had on maternal health services and outcomes, and to test the effect of level of father involvement on maternal health. Methods. This was a program evaluation conducted through representative household surveys administered at baseline in 2007 and endline in 2011 using 30 cluster samples randomly-selected from the 229 participating communities. Within each cluster, 10 households having at least one mother-child pair were randomly selected to complete a questionnaire, for a total of about 300 respondents answering close to 100 questions each. Changes in key outcome variables from baseline to endline were tested using logistic regression, controlling for mother's education and father's involvement. Results. There were improvements in most maternal health indicators, including an increase in women attending prenatal checkups (84% to 92%, P = 0.05) and institutional births (44% to 63%, P = 0.002). However, the involvement of the fathers decreased as reflected by the percentage of fathers accompanying mothers to prenatal checkups (48% to 41%, P = 0.01); the fathers' reported interest in prenatal care (74% to 52%...

Maternal health and health-seeking behaviors among indigenous Mam mothers from Quetzaltenango, Guatemala

Chomat,Anne Marie; Solomons,Noel W.; Montenegro,Gabriela; Crowley,Caitlin; Bermudez,Odilia I.
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2014 EN
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66.15%
OBJECTIVE: To obtain background information about maternal health and health-seeking behaviors among indigenous mothers living in rural Mam-Mayan communities of Quetzaltenango, Guatemala. METHODS: A cross-sectional analysis of 100 pregnant and breastfeeding women in four communities was performed to determine prevalence and determinants of service utilization. RESULTS: Extreme poverty, poor education, and poor access to basic resources were prevalent. Out of 100 women 14-41 years old, 33% did not use the formal health care sector for antenatal care; the majority consulted a traditional birth attendant. Only 13% delivered in a hospital. Lower socioeconomic status, lack of fluency in Spanish, and no ownership of a motorized vehicle were associated with the highest likelihood of poor utilization of services. CONCLUSIONS: A variety of factors affect utilization of maternal health services by indigenous women in rural Quetzaltenango. These include socioeconomic disparities, ethnic and linguistic differences, and poor access to basic resources. The current reproductive needs of women should be addressed to improve their health and increase their chance of having healthy children.