This guide provides a full range of updated, evidence-based norms and standards that will enable health care providers to give high quality care during pregnancy, delivery and in the postpartum period, considering the needs of the mother and her newborn baby. All recommendations are for skilled attendants working at the primary level of health care, either at the facility or in the community. They apply to all women attending antenatal care, in delivery, postpartum or post abortion care, or who come for emergency care, and to all newborns at birth and during the first week of life (or later) for routine and emergency care. This guide is a guide for clinical decision-making. It facilitates the collection; analysis, classification and use of relevant information by suggesting key questions, essential observations and/or examinations, and recommending appropriate research-based interventions. It promotes the early detection of complications and the initiation of early and appropriate treatment, including time referral, if necessary. Correct use of this guide should help reduce high maternal and perinatal mortality and morbidity rates prevalent in many parts of the developing world, thereby making pregnancy and childbirth safer.

The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.

These four papers supplement the book Contraception and Reproduction: Health Consequences for Women and Children in the Developing World by bringing together data and analyses that would otherwise be difficult to obtain in a single source. The topics addressed are an analysis of the relationship between maternal mortality and changing reproductive patterns; the risks and benefits of contraception; the effects of changing reproductive patterns on infant health; and the psychosocial consequences to women of controlled fertility and contraceptive use.

Experts estimate that nearly 60 percent of all U.S. pregnancies--and 81 percent of pregnancies among adolescents--are unintended. Yet the topic of preventing these unintended pregnancies has long been treated gingerly because of personal sensitivities and public controversies, especially the angry debate over abortion. Additionally, child welfare advocates long have overlooked the connection between pregnancy planning and the improved well-being of families and communities that results when children are wanted. Now, current issues--health care and welfare reform, and the new international focus on population--are drawing attention to the consequences of unintended pregnancy. In this climate The Best Intentions offers a timely exploration of family planning issues from a distinguished panel of experts. This committee sheds much-needed light on the questions and controversies surrounding unintended pregnancy. The book offers specific recommendations to put the United States on par with other developed nations in terms of contraceptive attitudes and policies, and it considers the effectiveness of over 20 pregnancy prevention programs. The Best Intentions explores problematic definitions--"unintended" versus "unwanted" versus "mistimed"--and presents data on pregnancy rates and trends. The book also summarizes the health and social consequences of unintended pregnancies, for both men and women, and for the children they bear. Why does unintended pregnancy occur? In discussions of "reasons behind the rates," the book examines Americans' ambivalence about sexuality and the many other social, cultural, religious, and economic factors that affect our approach to contraception. The committee explores the complicated web of peer pressure, life aspirations, and notions of romance that shape an individual's decisions about sex, contraception, and pregnancy. And the book looks at such practical issues as the attitudes of doctors toward birth control and the place of contraception in both health insurance and "managed care." The Best Intentions offers frank discussion, synthesis of data, and policy recommendations on one of today's most sensitive social topics. This book will be important to policymakers, health and social service personnel, foundation executives, opinion leaders, researchers, and concerned individuals. May

The main aim of this practical Handbookis to strengthen counselling and communication skills of skilled attendants (SAs) and other health providers, helping them to effectively discuss with women, families and communities the key issues surrounding pregnancy, childbirth, postpartum, postnatal and post-abortion care. Counselling for Maternal and Newborn Health Careis divided into three main sections. Part 1 is an introduction which describes the aims and objectives and the general layout of the Handbook. Part 2 describes the counselling process and outlines the six key steps to effective counselling. It explores the counselling context and factors that influence this context including the socio-economic, gender, and cultural environment. A series of guiding principles is introduced and specific counselling skills are outlined. Part 3 focuses on different maternal and newborn health topics, including general care in the home during pregnancy; birth and emergency planning; danger signs in pregnancy; post-abortion care; support during labor; postnatal care of the mother and newborn; family planning counselling; breastfeeding; women with HIV/AIDS; death and bereavement; women and violence; linking with the community. Each Session contains specific aims and objectives, clearly outlining the skills that will be developed and corresponding learning outcomes. Practical activities have been designed to encourage reflection, provoke discussions, build skills and ensure the local relevance of information. There is a review at the end of each session to ensure the SAs have understood the key points before they progress to subsequent sessions.