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Suggested citation: National Research Council (2000) The Consequences of Maternal Morbidity and Maternal Mortality: Report of a Workshop. Committee on Population. Holly E. Reed, Marjorie A. Koblinsky, and W. Henry Mosley, editors. Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.
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COMMITTEE ON POPULATION 1998
JANE MENKEN (Chair),
Institute of Behavioral Sciences, University of Colorado, Boulder
CAROLINE H. BLEDSOE,
Department of Anthropology, Northwestern University
JOHN BONGAARTS,
Population Council, New York City
DAVID A. LAM,
Population Studies Center, University of Michigan, Ann Arbor
LINDA G. MARTIN, RAND,
Santa Monica, California
MARK R. MONTGOMERY,
Population Council, New York City, and Department of Economics, State University of New York, Stony Brook
W. HENRY MOSLEY,
Department of Population and Family Health Sciences, Johns Hopkins University
ALBERTO PALLONI,
Center for Demography and Ecology, University of Wisconsin, Madison
JAMES P. SMITH, RAND,
Santa Monica, California
BETH J. SOLDO,
Department of Demography, Georgetown University
LINDA J. WAITE,
Population Research Center, University of Chicago
BARNEY COHEN, Director
HOLLY REED, Research Associate
ELIZABETH WALLACE, Project Assistant
WORKSHOP ON THE CONSEQUENCES OF PREGNANCY, MATERNAL MORBIDITY, AND MORTALITY FOR WOMEN, THEIR FAMILIES, AND SOCIETY
Presenters
MARTHA AINSWORTH,
World Bank, Washington, DC
ALAKA M. BASU,
Division of Nutritional Sciences, Cornell University
JACQUELYN C. CAMPBELL,
School of Nursing, Johns Hopkins University
WILLARD CATES, JR.,
Family Health International, Research Triangle Park, North Carolina
JULIA DAYTON,
Department of Epidemiology and Public Health, Yale University
SONALDE DESAI,
Department of Sociology, University of Maryland, College Park
STAN D'SOUZA,
International Population Concerns, Brussels, Belgium
RONALD H. GRAY,
School of Hygiene and Public Health, Johns Hopkins University
MARJORIE A. KOBLINSKY,
MotherCare/John Snow, Inc., Arlington, Virginia
LISA M. LEE,
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
REYNALDO MARTORELL,
Department of International Health, Emory University
JANE MENKEN,
Institute of Behavioral Sciences, University of Colorado, Boulder
KATHLEEN MERCHANT,
Community Well-Being International, Henderson, Nevada
W. HENRY MOSLEY,
Department of Population and Family Health Sciences, Johns Hopkins University
MEAD OVER,
World Bank, Washington, DC
JOY RIGGS-PERLA,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
CARINE RONSMANS,
Maternal and Child Epidemiology Unit, London School of Hygiene and Tropical Medicine, London
SHEA RUTSTEIN,
Macro International, Calverton, Maryland
JASON B. SMITH,
Family Health International, Research Triangle Park, North Carolina
MICHAEL A. STRONG,
U.S. Agency for International Development, Nairobi, Kenya
ANNE TINKER,
World Bank, Washington, DC
L. LEWIS WALL,
Louisiana State University Medical Center, New Orleans, and School of Public Health, Tulane University
KEITH P. WEST, JR.,
School of Hygiene and Public Health, Johns Hopkins University
Other Participants
CARLA ABOUZAHR,
World Health Organization, Geneva, Switzerland
JENNIFER ADAMS,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
FRANK ANDERSON,
Bureau for Humanitarian Response, U.S. Agency for International Development
PATRICIA BAILEY,
Family Health International, Research Triangle Park, North Carolina
ALFRED BARTLETT,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
INGVILD BELLE,
Inter-American Development Bank, Washington, DC
CYNTHIA BERG,
Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, Georgia
CAROLINE H. BLEDSOE,
Department of Anthropology, Northwestern University
ANNETTE BONGIOVANNI,
Bureau for Latin America and the Caribbean, U.S. Agency for International Development
SANDRA DECASTRO BUFFINGTON,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
LATASHA COLE,
Global Health Council, Washington, DC
COLLEEN CONROY,
MotherCare/John Snow, Inc., Arlington, Virginia
COLLETTE CURRAN,
Population Reference Bureau, Washington, DC
NILS DAULAIRE,
Global Health Council, Washington, DC
PATRICIA DAVID,
Population Reference Bureau, Washington, DC
FRANCE DONNAY,
UNICEF, New York, New York
LESLIE ELDER,
MotherCare/John Snow, Inc., Arlington, Virginia
PHYLLIS GESTRIN,
Bureau for Africa, U.S. Agency for International Development
MOLLY GINGERICH,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
JOHN HAAGA,
Population Reference Bureau, Washington, DC
SANDRA HUFFMAN,
Academy for Educational Development, Washington, DC
ZAHID HUQUE,
MotherCare/John Snow, Inc., Arlington, Virginia
EDNA JONAS, Consultant,
Silver Spring, Maryland
KATHERINE JONES,
Bureau for Humanitarian Response, U.S. Agency for International Development
MICHAEL KOENIG,
School of Hygiene and Public Health, Johns Hopkins University
KATHERINE KRASOVEC,
Abt Associates, Inc., Bethesda, Maryland
MIRIAM LABBOK,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
JEANNE McDERMOTT,
MotherCare/John Snow, Inc., Arlington, Virginia
THOMAS MERRICK,
World Bank, Washington, DC
MAUREEN NORTON,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
SHIRLIE PINKHAM,
Bureau for Population, Refugees, and Migration, U.S. Department of State
MIRIAM SCHNEIDMAN,
World Bank, Washington, DC
ELISABETH SOMMERFELT,
JHPIEGO Corporation, Baltimore, Maryland
MARY ELLEN STANTON,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
ANN STARRS,
Family Care International, New York, New York
PATRICIA STEPHENSON,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
KRISTA STEWART,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
REMA VENU,
UNICEF, New York, New York
VIRGINIA VITZTHUM,
Center for Population, Health, and Nutrition, U.S. Agency for International Development
BEVERLY WINIKOFF,
Population Council, New York
FAITH MITCHELL, Director,
Division on Social and Economic Studies
BARNEY COHEN, Director,
Committee on Population
HOLLY E. REED, Research Associate,
Committee on Population
ELIZABETH WALLACE, Project Assistant,
Committee on Population
Preface
The National Research Council (NRC) established the Committee on Population in 1983 to bring the knowledge and methods of the population sciences to bear on major issues of science and public policy. The committee's work includes both basic studies of fertility, health and mortality, and migration, and applied studies aimed at improving programs for the public health and welfare in the United States and developing countries. The committee also fosters communication among researchers in different disciplines and countries and policy makers in government and international agencies.
In 1997 the committee published Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions, a report that recommended actions to improve reproductive health for women around the world. As a follow-on activity, the committee proposed an investigation into the social and economic consequences of maternal morbidity and mortality. With funding from the William and Flora Hewlett Foundation, the Andrew W. Mellon Foundation, and the U.S. Agency for International Development, the committee organized a workshop on this topic in Washington, DC, on October 19-20, 1998.
A Committee on Population workshop is intended to be a stimulating forum for leading scientists and policy makers from a variety of different disciplines to discuss what is known about a particular scientific topic. The Workshop on the Consequences of Pregnancy, Maternal Morbidity, and Mortality for Women, Their Families, and Society brought together researchers from the fields of anthropology, demography, economics, medicine, public health, and sociology and policy makers from government agencies, nongovernmental, and international organizations. The goal of the workshop was to assess the existing scientific
knowledge about the consequences of maternal morbidity and mortality and to discuss key findings from recent research. Although the existing research on this topic is scarce, presenters drew on similar literature on the consequences of adult disease and death, especially the growing literature on the socioeconomic consequences of AIDS, to look at potential consequences from maternal disability and death.
Given the limitations of both time and scope that are inherent to a workshop, some other important topics could not be addressed. These included: the consequences of several types of morbidities, such as prolapse, eclampsia, ectopic pregnancy, and complications from unsafe abortion; the psychosocial affects of maternal morbidity and mortality; the fiscal costs of reproductive disability and death; and the changes in social structure that may result from maternal morbidity and mortality. The fact that they were not discussed does not indicate that they are not important topics deserving of future consideration.
This report summarizes the presentations and discussion at the workshop. Although some references are provided, it is by no means a comprehensive review of the subject. It is hoped that this report will encourage further investigation into the consequences of maternal morbidity and mortality.
I am grateful to my fellow committee members, Caroline Bledsoe, John Bongaarts, and Henry Mosley, who served with me on the subcommittee that organized the workshop. In addition, the committee was extremely fortunate in being able to enlist the services of Marge Koblinsky, one of the leading experts in this field. She collaborated with the committee members, provided valuable advice and direction during the planning stages of the meeting, and cochaired the meeting with Henry Mosley. Keith West, from the Johns Hopkins University and Leslie Elder, from John Snow, Inc. both helped to review the section on nutrition in this report.
The staff at the National Research Council managed the workshop from start to finish and made it all possible. Holly Reed, research associate, helped develop the framework for the workshop, coordinated the contributions of the participants, and worked with Marge Koblinsky and Henry Mosley to produce this report. Elizabeth Wallace, project assistant, assisted with logistical and travel arrangements for the workshop. Eugenia Grohman, associate director for reports for the Commission on Behavioral and Social Sciences and Education, skillfully edited the manuscript and guided it through the review process. The work was carried out under the general direction of Barney Cohen.
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 the 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 participation in the review of this report: Oona Campbell, Maternal and Child Epidemiology Unit, London School of Hygiene and Tropical Medicine; David A. Lam, Population Studies Center, University of Michigan, Ann Arbor; Deborah Maine, School of Public Health, Columbia University; T. Paul Schultz, Department of Economics, Yale University; and John Strauss, Department of Economics, Michigan State University.
Although the individuals listed above have provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with the authoring committee and the institution.
The work of the committee and the NRC, however, could not be done without the valuable contributions of experts who present their research and viewpoints in workshops like the one on which this report is based. (See Appendix B for the workshop agenda.) We are most grateful to these dedicated workshop participants, whose ideas and discussions are summarized here. We hope that this publication helps ensure that their work will continue to contribute to research and policy on reproductive and maternal morbidity and maternal mortality and their consequences.
Jane Menken, Chair
Committee on Population