BackgroundMaternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications.MethodSemi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis.ResultsTestimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it.ConclusionOur findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff

This study presents some new results on parental age as a risk factor for child survival. The study is based on individual registration forms for live births and infant deaths collected in Hungary from 1984 to 1988. Logistic regression models have been fitted for early neonatal and neonatal mortality on the one hand, and post-neonatal mortality on the other hand. Children of older males and females have significantly higher early neonatal and neonatal mortality rates compared to those of younger males and females. The impact of age of both parents remains, however, slighter than that of other biological characteristics such as previous number of fetal deaths, induced abortions, or live births. The authors discuss possible biological explanations.

The ability of infant mortality and health indicators to monitor health conditions in early infancy, and their broader use as indicators of the general level of socio-economic development are discussed from three points of view. These are: (i) the increasing impact of differences in legal definitions of live and stillbirths on the comparability of the infant mortality figures produced by vital statistics; (ii) the validity of mortality measures to monitor health; (iii) the comparability of social inequalities in infant health and mortality over time and across countries.

RésuméCet article examine le recours à la contraception dans les capitales de quatre pays africains, le Burkina Faso, le Ghana, le Maroc et le Sénégal. L’article cherche à répondre à deux questions : (i) quel est l’ordre hiérarchique des relations causales entre les caractéristiques individuelles associées au recours à la contraception dans les quatre populations urbaines considérées ? Plus particulièrement, (ii) comme l’instruction est un facteur majeur de la transition démographique, les données confirment-elles les deux chemins indirects allant de l’instruction au recours à la contraception qui ont été proposés dans la littérature, à savoir un chemin union-re­production et un chemin socio-culturel ? À partir d’une analyse secondaire des En­quêtes Démographie et Santé (EDS), la méthodologie se base sur des modèles structurels récursifs représentés par des graphes acycliques orientés. L’analyse em­pirique confirme l’importance de variables telles que le désir d’enfants et l’accord parental en matière de planification familiale pour expliquer le recours à la contraception. L’analyse met aussi en relief un chemin structurel union-reproduction as­sociant instruction féminine et recours à la contraception. En revanche, l’analyse aboutit à rejeter l’existence d’un chemin socioculturel, celui-ci étant infirmé par les données disponibles. La validité de ces résultats est discutée.AbstractThis study examined contraceptive use in the capital cities of four African countries, Burkina Faso, Ghana, Morocco and Senegal. The article sought to answer two questions: (i) what is the hierarchical ordering of causal relationships among the individual factors involved in the use of contraception in the four urban populations considered? More particularly, (ii) as education is a major factor of fertility transition, are two main indirect pathways that have been proposed in the literature (a union-reproductive path and a socio-cultural one), leading from women’s education to contraceptive use, confirmed by the data? Having recourse to a secondary analysis of Demographic and Health Survey (DHS) data, the methodology is based on recursive structural models represented by directed acyclic graphs. The empirical analysis confirms the importance of variables such as the desire for children and partner agreement on family planning in explaining contraceptive use. It also highlights a structural union-reproductive path linking female education and contraceptive use. On the contrary, the analysis leads to a tentative rejection of the socio-cul­tural path, as it is falsified by the data available. The validity of these results is discussed.

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