Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

IMPROVING BIRTH OUTCOMES

MEETING THE CHALLENGE IN THE DEVELOPING WORLD

Committee on Improving Birth Outcomes

Board on Global Health

Judith R. Bale, Barbara J. Stoll, and Adetokunbo O. Lucas, Editors

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

THE NATIONAL ACADEMIES PRESS
500 Fifth Sreet, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by the Centers for Disease Control and Prevention, the U.S. Agency for International Development, and the National Institute for Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services. The views presented in this report are those of the Institute of Medicine Committee on Improving Birth Outcomes and are not necessarily those of the funding agencies.

Library of Congress Cataloging-in-Publication Data

Improving birth outcomes : meeting the challenge in the developing world / Committee on Improving Birth Outcomes, Board on Global Health ; Judith R. Bale, Barbara J. Stoll, and Adetokunbo O. Lucas, editors.

p. ; cm.

Includes bibliographical references.

ISBN 0-309-08614-0, 0-309-52796-1 (PDF)

1. Infants (Newborn)—Developing countries—Mortality—Prevention. 2. Infants (Newborn)—Diseases—Developing countries—Prevention. 3. Fetal death—Developing countries—Prevention. 4. Fetus—Diseases—Developing countries—Prevention. 5. Mothers—Developing countries—Mortality—Prevention. 6. Infant health services—Developing countries. 7. Maternal health services—Developing countries. 8. Pregnancy—Complications—Developing countries—Prevention.

[DNLM: 1. Pregnancy Complications—prevention & control. 2. Pregnancy Outcome. 3. Developing Countries. 4. Infant Mortality. 5. Maternal Mortality. WQ 240 I34 2003] I. Bale, Judith R. II. Stoll, Barbara J. III. Lucas, Adetokunbo O. IV. Institute of Medicine (U.S.). Committee on Improving Birth Outcomes.

RJ60.D44I465 2003

362.1′989201′091724—dc22

2003014374

Additional copies of this report are available from the
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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

Shaping the Future for Health

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

COMMITTEE ON IMPROVING BIRTH OUTCOMES

ADETOKUNBO O. LUCAS(Co-Chair), Professor of International Health, Nigeria

BARBARA J. STOLL(Co-Chair),

Emory University School of Medicine, Atlanta, GA

ANNA ALISJAHBANA,

University of Pajajaran, Bandung, Indonesia

ABHAY BANG,

Society for Education, Action & Research in Community Health, Gadchiroli, India

LAURA CAULFIELD,

The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD

ROBERT GOLDENBERG,

University of Alabama at Birmingham, Birmingham, AL

MARGE KOBLINSKY,

Mother Care/John Snow, Arlington, VA

MICHAEL KRAMER,

McGill University, Montreal, Quebec, Canada

AFFETTE MCCAW-BINNS,

University of the West Indies, Jamaica, WI

KUSUM NATHOO,

University of Zimbabwe Medical School, Harare, Zimbabwe

HARSHAD SANGHVI,

Maternal and Neonatal Health Program, JHPIEGO Corp., Baltimore, MD

JOE LEIGH SIMPSON,

Baylor College of Medicine, Houston, TX

Staff

JUDITH R. BALE, Board Director and Study Director (until October 2002)

ALISON J. MACK, Consultant

SHIRA H. FISCHER, Research Assistant

JASON PELLMAR, Project Assistant

STEPHANIE BAXTER-PARROTT, Project Assistant (until July 2000)

LAURIE SPINELLI, Project Assistant (until July 2002)

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

BOARD ON GLOBAL HEALTH

DEAN JAMISON (Chair), Director,

Program on International Health, Education, and Environment, University of California at Los Angeles, and the World Health Organization, Geneva, Switzerland

YVES BERGEVIN, Chief,

Health Section, UNICEF, New York, NY

PATRICIA DANZON, Professor,

Health Care Systems Development, University of Pennsylvania, Philadelphia, PA

RICHARD FEACHEM, Executive Director,

The Global Fund, Geneva, Switzerland

NOREEN GOLDMAN, Professor,

Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ

MARGARET HAMBURG, Vice President for Biological Programs,

Nuclear Threat Initiative, Washington, DC

JEFF KOPLAN, Vice President for Academic Health Affairs,

Emory University, Atlanta, GA

ADEL A. F. MAHMOUD, President,

Merck Vaccines, Whitehouse Station, NJ

JOHN WYN OWEN, Secretary,

Nuffield Trust, London, United Kingdom

MARK L. ROSENBERG, Executive Director,

The Task Force for Child Survival and Development, Emory University, Decatur, GA

SUSAN SCRIMSHAW, Dean,

School of Public Health, University of Illinois at Chicago, Chicago, IL

JAIME SEPULVEDA AMOR,

National Institute of Public Health, Mexico

DAVID CHALLONER (Institute of Medicine Foreign Secretary), Vice President for Health Affairs, Emeritus,

University of Florida, Gainesville, FL

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:


CARLA ABOUZHAR, World Health Organization

H. DAVID BANTA, Consultant in Health Care Technology Assessment, Paris

FERNANDO C. BARROS, PAHO/WHO Latin American Center for Perinatology and Human Development, Montevideo, Uruguay

CYNTHIA BEALL, Case Western Reserve University

ZULFIQAR A. BHUTTA, The Aga Khan University

HOOSEN M. COOVADIA, University of Natal

ANTHONY COSTELLO, Institute of Child Health at Great Ormond Street, University College, London

LUELLA KLEIN, Department of Gynecology and Obstetrics, Emory University School of Medicine

ANVER KULIEV, Reproductive Genetics Institute

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

ALLAN ROSENFIELD, Columbia University

HELEN SMITS, Universidade Eduardo Mondlane

ANN TINKER, Save the Children Foundation


Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by ELAINE L. LARSON, Columbia University, New York, New York, and by ELENA NIGHTINGALE, National Research Council, Washington, DC. Appointed by the National Research Council and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

Acknowledgments

The Institute of Medicine acknowledges the committee for undertaking the development of both this comprehensive report and the companion report, Reducing the Impact of Birth Defects: Meeting the Challenge in the Developing World.

The successful completion of this report has required the input of many experts. The committee thanks the researchers and public health professionals who presented papers and provided insights at the workshop held in conjunction with the first committee meeting (see Appendix A). The committee also thanks the many experts who provided technical review and suggestions during the development of the report: Carlos Barros; Charles Carpenter; Myron Essex; Jean-Pierre Habicht; Joy Lawn; Reynaldo Martorell; and Catherine Wilfert.

The committee would like to thank staff and consultants in the Institute of Medicine whose contributions were instrumental to developing and producing this report: Judith Bale, who coordinated committee and other expert input; Alison Mack, who transformed report text; Pamela Mangu, who organized the first committee meeting; and Laurie Spinelli and Shira Fischer for their superb support at different stages of the report. Also valuable in the early development of the report was consultation with Helen Gelband, a paper prepared by Jeffrey Stringer, research provided by Patricia Cuff, Katherine Oberholtzer, Vanessa Larson, and interns Kevin Crosby, Nikki Williams, and Maria Vassileva. Appreciation is extended to Rona Briere for her expert editing of the report. Other staff who were instrumental in the final stages of this report include Bronwyn Schrecker,

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

Janice Mehler (National Academies), Jennifer Otten, Jennifer Bitticks, Stacey Knobler, and the NAP production staff. Andrea Cohen is acknowledged for her careful monitoring of study finances.

The committee appreciates the financial support for this report, which was provided by the Centers for Disease Control and Prevention, the U.S. Agency for International Development, and the National Institute for Child Health and Human Development, National Institutes of Health.

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.
Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.
  

 Recommendations,

 

153

  

 Research Needs,

 

153

  

 Conclusion,

 

153

  

 References,

 

154

Part III:   Improving Health Care Systems

 

 

5

 

IMPROVING BIRTH OUTCOMES WITHIN HEALTH CARE SYSTEMS

 

165

  

 The Evidence Base,

 

166

  

 Primary Care and Referral,

 

166

  

 Models of Care for Labor and Delivery,

 

168

  

 Improving Access to Referral Care for Labor and Delivery,

 

176

  

 Building Capacity for Reproductive Health Care,

 

178

  

 Staff Development and Training,

 

179

  

 The Role of the Private Sector,

 

180

  

 Financing,

 

182

  

 Health Care Reforms,

 

183

  

 Managing Health Care Systems,

 

184

  

 Surveillance,

 

185

  

 Evaluation,

 

189

  

 Recommendations,

 

191

  

 Research Needs,

 

193

  

 Conclusion,

 

193

  

 References,

 

194

Part IV:   Additional Causes of Neonatal Mortality and Morbidity

 

 

6

 

THE PROBLEM OF LOW BIRTH WEIGHT

 

205

  

 Patterns of Occurrence,

 

205

  

 Causes of IUGR and Preterm Birth,

 

207

  

 Consequences of IUGR and Preterm Birth,

 

212

  

 Effects on Mortality,

 

212

  

 Effects on Morbidity, Growth, and Development,

 

214

  

 Interventions to Prevent Preterm Birth and IUGR,

 

217

  

 Sources of Evidence,

 

217

  

 Prepregnancy Energy/Protein Supplementation,

 

217

  

 Energy/Protein Supplementation During Pregnancy,

 

218

  

 Nutritional Advice,

 

218

  

 Micronutrient Supplementation,

 

219

  

 Treatment of Genitourinary Infection,

 

220

  

 Smoking Cessation,

 

221

  

 Malaria Prophylaxis and Treatment,

 

221

  

 Other Interventions,

 

222

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.
Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.
Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

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Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.



IMPROVING BIRTH OUTCOMES

MEETING THE CHALLENGE IN THE DEVELOPING WORLD

Suggested Citation: "Front Matter." Institute of Medicine. 2003. Improving Birth Outcomes: Meeting the Challenge in the Developing World. Washington, DC: The National Academies Press. doi: 10.17226/10841.

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Next Chapter: Executive Summary
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