Prenatal Care Reaching Mothers, Reaching Infants (1988) / Chapter Skim
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Appendix B: Prenatal Care Outreach: An International Perspective
Appendix B: Prenatal Care Outreach: An International Perspective
Pages 210-228
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From page 210... ...
Policy, published by the National Center for Clinical Infant Programs, Washington, D.C., 1987. The work was supported by a Fulbright Grant and the Ford Foundation, and was facilitated by Marsden Wagner, Regional Officer for Maternal and Child Health, World Health Organization, Regional Office for Europe, Copenhagen.
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From page 211... ...
In addition, I visited academics, health officials, researchers, and clinic providers in Denmark, Federal Republic of Germany, Netherlands, Belgium, and the United Kingdom. Experts from each of these countries were asked to review the ensuing report, and I have incorporated their suggestions for revision.
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From page 212... ...
Ten countries remained for analysis (see Table 11. TABLE 1 Rates of Infant Mortality and Low Birthright in the Study Countries, 1982a Infant Mortality Low Birthweight Country Rateb RateC Belgium 10.10 5 Denmark 7.71 6& France 9.40 5 Federal Republic of Germany 10.20 5 Ireland 10.10 4 Netherlands 8.40 ~ Norway 7.90 4 Spain 9.60 NA Switzerland 7.60 5 United Kingdom 10.00 7 aThe infant mortality rate is the number of deaths per 1,000 births.
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From page 213... ...
. A study committee working on behalf of the European Economic Community has conducted a survey of teaching hospitals on the recommended content of prenatal visits.
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From page 214... ...
These strategies are considered to be less expensive than hospital care, but careful cost-benefit analyses are not generally available. An exception is the Netherlands, where the expense of the extensive postnatal home visiting program has come under review.
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From page 215... ...
In Sweden (not included among the study countries) non-Nordic immigrant families were shown to use health services extensively and to have pregnancy outcomes that were comparable to, if not more favorable than, those of Swedes (Smedby and Ericson, 19799.
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From page 216... ...
The average number of prenatal visits varies between 10 and 14 in all parts of the country. Pregnant women who live in remote areas are reimbursed for travel expenses and subsistence for 10 days in order to be near a hospital when delivery is expected.
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From page 217... ...
Redistribution of household income to reduce poverty might bring about many benefits, including a reduction in infant mortality rates. But the record clearly indicates that household wealth far below the U.S.
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From page 218... ...
They have also TABLE 3 Difference Between Highest and Lowest Quintiles in Proportional Share of Total Household Income in the United States and the Study Countries, 1979-1982 Country Difference Belgium Netherlands Switzerland Federal Republic of Germany Ireland (1973) Norway United Kingdom Spain Denmark United States France (1975)
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From page 219... ...
Even in Switzerland, probably the most privatized system of health care among the 10 study countries, national standards for perinatal service are defined and their implementation subsidized by government grants to the insurance compan~es. Health Care Financing and Delivery Financing systems for health care are strikingly different among the countries and bear no consistent relationship to differences in prevailing health care provider systems.
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From page 220... ...
A 1984 government report in Norway recommends 12 prenatal visits for uncomplicated pregnancies, half of them to a midwife and half to a general practitioner. In most countries, midwives attend uncomplicated deliveries for women who have received routine prenatal care from office-based general practitioners.
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From page 221... ...
TABLE 4 Prenatal Visits in the Study Countries, 1981-1982 Country Number Recommended Average Actual or Legally Required Number Belgium (French-speaking sector) 7 Denmark 10 Federal Republic of Germany 10 France 7 Ireland 6 Netherlands Norway Spainb Switzerland United Kingdom aVandenbussche et al., 1985.
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From page 222... ...
Netherlands Only for complicated pregnancies or to check on clinic nonattenders Belgium Federal Republic of Germany (not an extensive program) France Irelandb Norway Switzerland United Kingdomb POSTNATAL VISITS Always at least once Belgium Denmark Ireland Netherlands (daily visits for up to 8 hours through tenth day postpartum)
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From page 223... ...
For this service the family pays only a token fee. In all countries, postnatal home visiting is seen as a means for counseling about infant care, for follow-up on the mother's health, for advice on family planning, for initial or follow-up neonatal screening procedures, and for setting up additional appointments for the infant and mother.
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From page 224... ...
The Netherlands provides for deliveries that are neither fully hospitalbased nor fully home-based. A polyclinic delivery allows a woman and her attending midwife to arrange for delivery on hospital premises, stay for up to 36 hours, and then return home for the usual pattern of home visiting.
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From page 225... ...
Usual practice in most countries is to transfer women to nonstrenuous jobs as soon as pregnancy is confirmed. Night work for pregnant women is forbidden in the Netherlands, Belgium, Switzerland, and Federal Republic of Germany, although exceptions may be made in certain job categories or with the woman's consent.
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From page 226... ...
CONCLUSIONS Review of pregnancy-related supports and services in 10 Western European countries with outstanding records of infant survival and low
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From page 227... ...
Most of the countries surveyed have established impressive programs of outreach featuring home visiting, which is designed primarily to prolong and enrich prenatal care rather than recruit women into care. Women appear to be attracted to prenatal care in order to avail themselves of the substantial medical and social benefits that attach to pregnancy and childbearing.
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From page 228... ...
1984. Prenatal care and infant mortality: The French experience.
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