Preganacy_and_Birthing_in_Lao

In 2006 Liz Eckermann published findings of a case study that was conducted on the theory that are the risk regimes faced and perceived by pregnant women in rural Lao PDR substantially differ from those experienced by pregnant women in western societies' And if the Lao experiences and perceptions are different, can improvements in maternal health in Lao PDR be achieved. The major dependent is Maternal Mortality Ratio this also included the Millennium Developmental Goal case study Lao PDR: Progress on MDG 5 targets 1990-2015. The independent variables were dimensions of difference such as ethnicity, age, geographical location, in particular rural living and social class. As well as the multitude of birthing options, economic imperatives and insurance arrangements, varies with social, economics and demographic positioning. Despite a steady reduction in maternal mortality ratio (MMR) since 1990, Lao still has one of the highest MMR. Maternal deaths per 100,000 live births in Western Pacific region (Tulloch/Ausaid 2005, WHO 2006). In rural and remote communities the figures are more than double the national average. (Abouzahr 1996, Government of Lao PDR 2004). Millennium Development Goal (MDG) 6 of the 2015 (MDG) 5 on maternal mortality which is to reduce by three quarters between 1990 and 2015 the maternal mortality ratio, Lao PDR has established 3 sets of indicators to measure progress on target 6: MMR proportion of births attended by skilled health personnel and contraceptive prevalence rate (Government of Lao PDR 2004). Currently the country falls short on two indicators, namely MMR and proportion of births attended by skilled health personnel. The decrease in Lao PDR’s official MMR from 750 deaths per 100,000 live births in 1990 to 530 deaths per 100,000 live births in 2000 has been mainly attributed to prevention strategies such as improved family planning access, immunization and reduction of anemia by dietary supplements. Western prevention strategies for improving maternal health outcomes have been incorporated by Lao government into there maternal and child health planning and programs with a high acceptance rate among the population. In particular the increase in contraceptive prevalence rates from 13% to 32% has certainly had an impact, However more clinical interventionist strategies such as attendance at births by skilled personnel. The percentage of births attended by skilled personnel increased by 3% between 1994 and 1999(14% to 17%) well short of the 2015 target 80% MDG target for MMR in 2015 of less than 185 deaths per 100,000 live births a major force is needed to increase attendance at births by skilled personnel. The proven interventions against the four major causes of maternal death hemorrhage, puerperal infections, eclampsia and obstructed labor. Involve prevention, primary clinical care, basic essential obstetric care and emergency obstetric care, disabling outcomes that are often reported among women who deliver in hospitals and clinics. Yet less than 10% of mothers deliver in health care facilities. What happens to those women who deliver else were and suffer complications. Why do they not use the available facilities' Lack of access to and utilization of, prenatal and birthing services is just one of the factors exacerbating geographical and environmental barriers to maternal health and safety. It is often assumed that this is mainly because of distance and difficult terrain. When an obstetrical complication appears it is often too late to reach appropriate medical intervention. Other factors also operate, as evidence by the low usage of maternal health care facilities even by those who live close to one. Economic factors include the cost of hospitalization and prescriptions, the unwillingness of a woman to interrupt their work and leave the fields for more than a day to give birth. Another factor which has operated as a disincentive to health facility usage in the past has been the unwillingness on behalf of the hospital and clinic administrators to cater for traditional practices such as soul calling ceremonies after a cesarean birth, traditional dietary restrictions and smoking of the mother and baby over a fire after birth. One initiative of Lao PDR government in partnership with WHO and UNDP which addresses these problems has been the establishment of a pilot program Maternity Waiting Home (MWH) near the Bolikhan District Hospital and accompanying outreach program in eleven villages. The concept of providing supervised shelter for pregnant women with potential risks has a long history spanning several centuries these pregnancy risk include first time mother’s, women with many pregnancy, very young, older women and those identified as having medical problems like hypertension. The most recent concept is the maternity waiting home is a setting where women can be accommodated during the final weeks of pregnancy close to a facility were obstetric care is available and where women can be transferred immediately to a hospital for emergencies. It offers a range of services including postnatal health promotion and education as well as prenatal care in a relaxed environment. Another unique feature of the Bolikhan MWH is the intention to preserve traditional practices that form part of the women’s culture. Only those traditional practices that are harmful to mother and baby are not negotiable and are discouraged through health promotion and education. This includes using smoke instead of steam to warm the mother and baby and discarding the colostrum rather than feeding it to the baby. Given that some women cannot access the MWH training of other healthcare workers by the program teams from MWH have been introduce to the villages to screen for symptoms such as eclampsia hypertension and anemia and to undertake home deliveries. The evaluation research found that the MWH has improved access to essential and emergency obstetric care in Bolikhan district. The substantial increase in births at the BDH in the 3 months since MWH had opened revealed that the MWH has been successful in bringing pregnant women within close proximity to both essential and emergency obstetric services. The results suggest different risk perceptions and experiences between Lao and western communities based on contrasting views of beliefs, culture and identity. In Lao rural communities studied there is little evidence yet of risk society despite the introduction of western technologies and practices to improve maternal mortality and morbidity it is to argue that the risk society can be avoided. References Eckermann, L. (2006, October). Finding a 'safe' place on the risk continuum: a case study of pregnancy and birthing in Lao PDR. Health Sociology Review, 15(4), 374-386.