Infant Mortality and Obstetric Assistance’s Quality - Revista Brasileira de Ginecologia e Obstetrícia

Infant Mortality and Obstetric Assistance’s Quality |

A worldwide acknowledged way of evaluating the life conditions of a population, in particular or in general, is to use health indicators that may be represented as rates or ratios. Such indexes are essential for the quality of the planning of programs and services, interfering directly in their efficiency. Furthermore, those indicators reflect substantially the quality of the assistance provided to the individuals. The relationship between women's life conditions and infant mortality is unquestionable, especially regarding family planning and obstetric assistance.

Infant mortality corresponds to the number of deaths of infants per 1,000 live births, in a given year, in the population living in a specific geographic area. In general, this number reflects the socioeconomic development and environmental infrastructure, as well as the access to and the quality of the resources available for maternal and child health care. Infant mortality has 3 important components: early neonatal mortality, which estimates the number of deaths among live births in the first 6 days of life; late neonatal mortality, which estimates the number of deaths among live births between 7 and 27 days of life, and post neonatal mortality, which is calculated using the number of deaths among live births between 28 and 364 completed days of life. The neonatal component is the one that suffers the influence of socioeconomic and women's health conditions the most, as well as that of the prenatal, childbirth and newborn assistance quality. Nevertheless, the coefficients that best reflect women's quality of life, and mainly of prenatal, childbirth and newborn assistance quality, are the perinatal mortality rate and the maternal mortality ratio. Perinatal mortality is represented by the number of deaths during the perinatal period (fetus deaths after 22 completed weeks of pregnancy up to 6 completed days after birth) per a total of 1,000 births (the total of live births and fetus deaths) in the population living in a specific geographic area, in a given year. The ratio of maternal deaths represents the number of maternal deaths per 100 thousand live births to mothers who live in a specific geographic area, in a given year. Maternal deaths are the ones that happen during the pregnancy or up to 42 days after its ending, regardless of the pregnancy's duration or the mother's geographic location, due to any cause related with or aggravated by pregnancy, or by measures adopted in relation to it, excluding accidental or incidental causes. A significant limitation for the correct estimation of such coefficients is the percentage of deaths and births not informed to the health system. In calculating maternal mortality, another important limitation for the indicator's accuracy is the incorrect filling out of death certificates that, at times, does not make explicit the existence of pregnancy in the chain of events that directly or indirectly led to the death of the woman of childbearing age.

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