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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
medical services for delivery, while in the other one-half of the countries less than 50 percent did so.
Latin American and Caribbean countries have somewhat higher coverage rates than sub-Saharan African countries. In 3 of 11 Latin American countries (Trinidad and Tobago, the Dominican Republic, and Colombia), more than 75 percent of women both used prenatal care and gave birth with the assistance of a professional health care provider. In five countries, prenatal coverage rates ranged between 50-75 percent, and four of these had delivery assistance in the same range. Bolivia had prenatal care coverage in that range, but delivery assistance was slightly lower at 47 percent. In only one country, Guatemala, was coverage for both types of services less than 50 percent (Macro International, Inc., 1994).
In the Asian countries surveyed, three-quarters of pregnant women used prenatal care, covering women in Indonesia, Philippines, Sri Lanka, and Thailand; in Bangladesh and Pakistan, only one-quarter of women used prenatal care. Three of every four Sri Lankan women, one-half of Thai women, and two-thirds of Philippino women had a professional attending their deliveries. In the remaining three countries, Bangladesh, Pakistan, and Indonesia, between one and three out of every ten women had a professional in attendance.
Data on the use of postpartum services are relatively scarce, but the rates are typically lower than rates of institutional delivery. In the African countries for which data are available, coverage for postpartum care has for the most part not exceeded 40 percent, even in urban areas. Latin American rates are slightly higher than those for Africa, and Asian women seem the most likely to attend a postpartum clinic. However, data are sparse, and information is not available on the types of providers who are serving women in this period nor women's reasons for seeking such care (World Health Organization, 1993a). Even rates of coverage provide little information about the quality of care or the reasons for its use.1 What these coverage rates do show is that a substantial portion of women remain outside delivery and postpartum services for reasons that could range from taboos on mobility to preference to remain at home to the unavailability or inaccessibility of appropriate care. Women living in rural areas or having no education use all these services less than other women, while differences in age, parity, and birth interval are less consistent in determining coverage rates (Govindasamy et al., 1993).
When facilities exist, service providers may lack the basic equipment and supplies, the person with the appropriate skills may be absent, or routine monitoring during pregnancy, labor, and delivery or in the puerperium may result in no follow-up of abnormal findings.