Reduced maternal mortality in Tunisia and voluntary commitment to gender-related concerns

Farhat, Essia Ben; Chaouch, Mohamed; Chelli, H.; Gara, Mohamed Faouzi; Boukraa, Noureddine; Garbouj, M.; Hamrouni, Mongi; Fourati, A; Calvez, Thierry; Thonneau, Patrick

doi:10.1016/j.ijgo.2011.10.010

Cited by 15 publications

(19 citation statements)

References 13 publications

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“…38–60 The majority of studies (n=32) reported pregnancy-related deaths while three studies reported maternal deaths. 27,46,51 Studies were published in English, Spanish and Portuguese.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies used reproductive-age mortality surveys (RAMOS) 26,27,38,45,53,59 and eleven studies used routine data from multiple sources such as local registries, hospital-based records, data of management information systems and/or by conducting interviews with health attendants. 29,30,44,46,49,51,52,54,55,58,60 Eight confidential enquiries into maternal deaths enumerated deaths from facility-based records.…”

Section: Resultsmentioning

confidence: 99%

“…41,47,50,53,54,59 Two VA studies interpreted data using Inter VA-models. 40,43 All other studies (n=19) used reviews of physicians and/or other health professionals to establish the cause of the pregnancy-related deaths by using RAMOS (n=3) 27,38,44 , routine data (n=6) 30,46,51,52,55,58 , surveillance 37 or confidential enquiries (n=8) 31–36,56,57 , while one study asked relatives what the cause of death was. 26 …”

Section: Resultsmentioning

confidence: 99%

“…The exclusion of injuries from the ICD-10 definition of maternal death has clearly been met with unease since a number of studies in this review considered suicide as an indirect maternal death 27,46,51 although no study classified suicide as direct obstetric as recommended in the latest WHO revision of causes of maternal death for ICD-11. 12 One study went even further by only considering postpartum suicide as directly attributable to pregnancy, while antenatal suicide was thought to be coincidental to pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Fuhr

Calvert

Ronsmans

et al. 2014

The Lancet Psychiatry

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Summary Background Although suicide is one of the leading causes of deaths among young women in low and middle-income countries (LMIC), the contribution of suicide and injuries to pregnancy-related mortality remains unknown. Methods We conducted a systematic review to identify studies reporting the proportion of pregnancy-related deaths attributable to suicide and/or injuries in LMIC. Random-effects meta-analysis was used to calculate the pooled prevalence of pregnancy-related deaths attributable to suicide, stratified by WHO region. To account for the possible misclassification of suicide deaths as injuries, we calculated the pooled prevalence of deaths attributable to injuries, and undertook a sensitivity analysis reclassifying the leading methods of suicides among women in LMIC (burns, poisoning, falling or drowning) as suicide. Findings 36 studies from 21 countries were identified. The pooled total prevalence across the regions was 1·00% for suicide (95% confidence interval (CI): 0·54–1·57) and 5·06% for injuries (95% CI: 3·72–6·58). Reclassifying the leading suicide methods from injuries to suicide increased the pooled prevalence of pregnancy-related deaths attributed to suicide to 1·68% (95% CI: 1·09–2·37). Americas (3·03%, 95% CI: 1·20–5·49),the Eastern-Mediterranean region (3·55%, 95% CI: 0·37–9·37), and the South-East Asia region (2·19%, 95% CI: 1·04–3·68) had the highest prevalence for suicide, with the Western-Pacific region (1·16%, 95% CI: 0·00–4·67) and the Africa region (0·65%, 95% CI: 0·45–0·88) having the lowest. Interpretation The available data suggest a modest contribution of injuries and suicide to pregnancy-related mortality in LMIC with wide regional variations. However, this study may have underestimated suicide deaths due to lack of recognition and inclusion of these causes in eligible studies. We recommend that injury-related and other co-incidental causes of death are included in the WHO definition of maternal mortality to promote measurement and effective intervention for reduction of maternal mortality in LMIC.

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“…38–60 The majority of studies (n=32) reported pregnancy-related deaths while three studies reported maternal deaths. 27,46,51 Studies were published in English, Spanish and Portuguese.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Fuhr

Calvert

Ronsmans

et al. 2014

The Lancet Psychiatry

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“…International documents and national studies have emphasized the effects of gender relations in reducing maternal deaths. In Tunisia, credit for improvements in maternal mortality ratio goes to a voluntary political commitment on gender related concerns, including access to family planning; legalization of abortion; the creation of the National Board for Family and Population, and the Tunisian Safe Motherhood initiative in 1999 (Farhat et al 2011). …”

Section: Factors Contributing To Maternal Deathsmentioning

confidence: 99%

Mortality in an International Perspective

Anson¹

2014

European Studies of Population

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The book series European Studies of Population (ESPO) aims at disseminating population and family research, with special relevance for Europe. It may analyse past, present and/or future trends, as well as their determinants and consequences. The character of the series is multidisciplinary, including formal demographic analyses, as well as social, economic and/or historical population and family studies. The following types of studies are of primary importance: (a) internationally relevant studies, (b) European comparative studies, (c) innovative theoretical and methodological studies, and (d) policy-relevant scientific studies. The series may include monographs, edited volumes and reference works. The book series is published under the auspices of the European Association for Population Studies (EAPS).

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The role of midwives in first-trimester abortion care: A 40-year experience in Tunisia

Hajri¹,

Belhadj²

2020

Int J Gynecol Obstet

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This is an open access article distributed under the terms of the Creative Commons Attribution IGO License, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or the article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's URL.

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Reduced maternal mortality in Tunisia and voluntary commitment to gender-related concerns

Cited by 15 publications

References 13 publications

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Contribution of suicide and injuries to pregnancy-related mortality in low-income and middle-income countries: a systematic review and meta-analysis

Mortality in an International Perspective

The role of midwives in first-trimester abortion care: A 40-year experience in Tunisia

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