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With additional social support and counseling, women may be able to successfully reintegrate socially following fistula repair.

Evidence suggests that cesarean birth rates are high and increasing in some developing countries. The objectives of this study are to compile the best current estimate of cesarean birth rates for developing countries, to estimate regional rates, and to document trends nationally and by urban/rural residence where data permit. A database of cesarean birth rates was compiled representing 90 percent of births in the developing world, resulting in an estimated cesarean birth rate for the developing world of 12 percent, with regional rates ranging from 3 to 26 percent. Data representing 45 percent of births in the developing world show that a majority of countries experienced increases in cesarean birth rates during the 1990s, except in sub-Saharan African countries, where little if any change occurred. Cesarean birth rates must be monitored routinely to call attention to rapidly changing practices. These data can, in turn, trigger investigation into the appropriateness of the rate in a given context.

Obstetric fistula is gaining visibility within national and international public health agencies. With increased attention to this dire condition comes the demand for better epidemiologic data. This article assesses the current state of knowledge regarding population-based estimates of the incidence and prevalence of obstetric fistulas; proposes a method for better estimating these rates; and discusses the feasibility of this method. We show that there are no solid population-based estimates of the numbers of obstetric fistulas anywhere (the estimate from the most rigorous study being based on only 2 reported fistula cases); and for advocacy purposes, we recommend using the estimates from the 1990 Global Burden of Disease report. To estimate the incidence and prevalence of obstetric fistula, we propose an adaptation of the sibling-based method for direct estimation of maternal mortality. A series of questions are proposed for this use and sample size calculations are provided. The questions may require refinement, however, and we invite research groups to consider testing them.

Cesarean section surgery is the clinical response used to prevent several of the leading causes of maternal and perinatal mortality and morbidity. Given the deficient state of health-information systems in most developing countries, nationally representative surveys are currently the most widely available source of population-based cesarean birth data. The purpose of this study is to assess the quality and internal consistency of Demographic and Health Survey cesarean birth data across countries and time periods. Although these surveys are highly standardized, the formulation of the question on cesarean birth and the categories of women who are asked the question often differ across surveys. A skip pattern that restricts the cesarean question to women who delivered in a health-care facility improves the internal consistency of the data, although in some countries cesarean deliveries are still reported at low-level, presumably nonsurgical facilities. Recommendations are made for improving data analysis and the future collection of population-based cesarean birth data.

Background:In high-prevalence populations, HIV-related maternal mortality is high with increased mortality found among HIV-infected pregnant and postpartum women compared to their uninfected peers. The scale-up of HIV-related treatment options and broader reach of programming for HIV-infected pregnant and postpartum women is likely to have decreased maternal mortality. This systematic review synthesized evidence on interventions that have directly reduced mortality among this population.Methods:Studies published between January 1, 2003 and November 30, 2014 were searched using PubMed. Of the 1,373 records screened, 19 were included in the analysis.Results:Interventions identified through the review include antiretroviral therapy (ART), micronutrients (multivitamins, vitamin A, and selenium), and antibiotics. ART during pregnancy was shown to reduce mortality. Timing of ART initiation, duration of treatment, HIV disease status, and ART discontinuation after pregnancy influence mortality reduction. Incident pregnancy in women already on ART for their health appears not to have adverse consequences for the mother. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality.Conclusions:ART was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and treatment.Global Health Implications:Maternal mortality is a rare event that highlights challenges in measuring the impact of interventions on mortality. Developing effective patient-centered interventions to reduce maternal morbidity and mortality, as well as corresponding evaluation measures of their impact, requires further attention by policy makers, program managers, and researchers.