Impact of diet on lead in blood and urine in female adults and relevance to mobilization of lead from bone stores. (1/514)

We measured high precision lead isotope ratios and lead concentrations in blood, urine, and environmental samples to assess the significance of diet as a contributing factor to blood and urine lead levels in a cohort of 23 migrant women and 5 Australian-born women. We evaluated possible correlations between levels of dietary lead intake and changes observed in blood and urine lead levels and isotopic composition during pregnancy and postpartum. Mean blood lead concentrations for both groups were approximately 3 microg/dl. The concentration of lead in the diet was 5.8 +/- 3 microg Pb/kg [geometric mean (GM) 5.2] and mean daily dietary intake was 8.5 microg/kg/day (GM 7.4), with a range of 2-39 microg/kg/day. Analysis of 6-day duplicate dietary samples for individual subjects commonly showed major spikes in lead concentration and isotopic composition that were not reflected by associated changes in either blood lead concentration or isotopic composition. Changes in blood lead levels and isotopic composition observed during and after pregnancy could not be solely explained by dietary lead. These data are consistent with earlier conclusions that, in cases where levels of environmental lead exposure and dietary lead intake are low, skeletal contribution is the dominant contributor to blood lead, especially during pregnancy and postpartum.  (+info)

The Safe Motherhood Initiative: why has it stalled? (2/514)

Complications of pregnancy and childbirth are still the leading cause of death and disability among women of reproductive age in developing countries. After decades of neglect, the founding of the Safe Motherhood Initiative in 1987 promised action on this problem. A dozen years later, there is no evidence that maternal mortality has declined and there are still few sizeable programs. A major reason for this disappointing record is that the initiative lacks a clear, concise, feasible strategy. This article reviews the available options and proposes a strategy based on improving the availability and quality of medical treatment of obstetric complications. Once district hospitals and health centers provide such needed care, community mobilization to improve prove utilization may be beneficial. Substantial reductions in maternal deaths would be possible in a relatively short period of time if this strategy were embraced.  (+info)

Media watch. (3/514)

In late 1997, Sharon Bernstein, a 35-year-old Los Angeles Times journalist and a new mother, was assigned the county hospital beat. Recently pregnant, the reporter was drawn towards stories of maternal and fetal health. So, she decided to look into obstetric malpractice claims against county hospitals. What she uncovered would change county hospital policy, lead to an assembly bill, and rekindle the medical debate about the safety of lowering Caesarean section (C-section) rates.  (+info)

Use of hospital data for Safe Motherhood programmes in south Kalimantan, Indonesia. (4/514)

The evaluation of Safe Motherhood programmes has been hampered by difficulties in measuring the preferred outcomes of maternal mortality and morbidity. The need for adequate indicators has led researchers and programme managers alike to resort to indicators of utilization and quality of health services. In this study we assess the magnitude of four indicators of use of essential obstetric care (EOC) and one indicator of quality of care in health facilities in three districts in South Kalimantan, Indonesia. The general picture which emerges for South Kalimantan is that the use of obstetric services is low. Even in the more urban district of Banjar where facility-based coverage is highest, fewer than 14% of all deliveries take place in an EOC facility, 2% of expected births are admitted to such a facility with a major obstetric intervention (MOI), and 1% of expected births have an MOI for an absolute maternal indication. The use of facility-based EOC is consistently lower in Barito Kuala compared to the other districts, and the differences persist regardless of the indicators used. In this setting with low utilization rates, general rates of utilization of EOC facilities seem to be as satisfactory an indicator of relative access to EOC as more elaborate indicators specifying the reasons for admission. The inequalities in access to care revealed by the various indicators of use of EOC services may prove to be a more powerful stimulus for change than the widely reported and highly inaccurate accounts of the high levels of maternal mortality.  (+info)

Assessing the effects of welfare reform policies on reproductive and infant health. (5/514)

OBJECTIVES: The welfare reform law of 1996 marked a historical moment in US policy toward the poor by ending the entitlement to cash assistance, by requiring work, and by establishing time limits. This article examines the potential impact on the health of women and children, the primary recipients of welfare benefits. METHODS: The authors outline the reproductive health outcomes most likely to be sensitive to welfare policies, identify indicators that might be used to assess these outcomes, review empirical evidence, and suggest specific methods and data sources. RESULTS: State welfare requirements could improve health outcomes or deter families from Medicaid and food stamps, as well as income support, thus worsening health outcomes. National and state data may prove useful in detecting these effects; however, new data sources may be required for specific health-related questions. CONCLUSIONS: Assessing the effects of welfare policies on reproductive and infant health is possible, although challenging. Reauthorization of the legislation is required in 2002; it is essential that the consequences for health be included in the next round of public debate.  (+info)

Sex ratios, family size, and birth order. (6/514)

In many countries, the male:female ratio at birth has varied significantly over the past century, but the reasons for these changes have been unclear. The authors observed a close parallel between decreasing family size and declining male:female sex ratio in Denmark from 1960 to 1994. To explain this finding, they examined the sex ratio and birth order of 1,403,021 children born to 700,030 couples. Overall, 51.2% of the first births were male. However, families with boys were significantly more likely than expected to have another boy (biologic heterogeneity). By the fourth birth to families with three prior boys, 52.4% were male. The increase varied directly with the number of prior boys (p for trend = 0.0007). Furthermore, couples with boys were more likely to continue to have children. In summary, the authors found that the declining male:female ratio in Denmark and probably other European populations is mainly attributable to three effects: declining family size, biologic heterogeneity, and child sex preference. Why families with boys are more likely to have additional boys is unknown.  (+info)

Reducing perinatal HIV transmission in developing countries through antenatal and delivery care, and breastfeeding: supporting infant survival by supporting women's survival. (7/514)

In 1998, a joint UNAIDS/UNICEF/WHO working group announced an initiative to pilot test an intervention to reduce perinatal transmission of human immunodeficiency virus (HIV), based on new guidelines on HIV and infant feeding. This intervention for developing countries includes short-course perinatal zidovudine (AZT) treatment and advice to HIV-positive women not to breastfeed their infants, where this can be done safely. The present paper raises questions about the extent of the public health benefit of this intervention, even though it may be cost-effective, due to the limited capacity of antenatal and delivery services to implement it fully. It argues that it is necessary to provide universal access to replacement feeding methods and support in their safe use, not only for women who have tested HIV-positive during pregnancy, but also for untested women who may also decide not to breastfeed, some of whom may be infected with HIV or may acquire HIV during the breastfeeding period. It further argues that additional funding, more staff, staff training, and improved capacity and resources are also needed to integrate this intervention successfully into antenatal and delivery care. The intervention will prevent some infants from getting HIV even in the absence of many of these changes. However, a comprehensive approach to HIV prevention and care in developing countries that includes both women and infants would promote better health and survival of women, which would in turn contribute to greater infant health and survival. If combination antiretroviral therapy in the latter part of pregnancy and/or during the breastfeeding period can be shown to be safe for infants, preliminary evidence suggests that it might reduce perinatal HIV transmission as effectively as the current intervention and, in addition, might allow the practice of breastfeeding to be preserved.  (+info)

Pregnancy intentions may not be a useful measure for research on maternal and child health outcomes.(8/514)