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African Journal of Reproductive Health, Vol. 6, No. 2, August, 2002 pp. 115-116 BOOK REVIEW Maternity Care in Developing Countries Friday Okonofua Code Number: rh02028 Maternity Care
in Developing
Countries Reviewer: Friday Okonofua This 422-paged book first published in 2001, is the most recent book that provides essential information on maternity care for clinicians working in developing countries. As the editors reveal in its preface, the book is a radical revision of an earlier book entitled Obstetrics and Gynaecology in the Tropics and Developing Countries, edited by J. B. Lawson and D. B. Stewart first published by Edward Arnold in 1967 and which remained in print until 1991. Those familiar with this book popularly called “Lawson and Stewart” in many medical schools in Africa, will agree that for several years it served as an important reference for clinicians, undergraduate and post-graduate medical students and midwives in many developing countries. Thus, it was with great anticipation that practitioners in developing countries awaited this new revised version, as it was expected to similarly lead the way on present-day thinking and practices regarding maternity care within the context of developing countries. I last met the late Professor J B Lawson at a workshop on reproductive health in developing countries in Uppsala, Sweden in the summer of 1996, and it was with great enthusiasm that he informed me that he and his team were working on revising his highly popular book. Although he did not live long enough to complete the editing of the book, it was delightful that he left the work in the hands of a highly competent team. Professor Kelsey Harrison is well known worldwide for his highly successful study that described the situation of obstetric care in Zaria, northern Nigeria1. There was evidence that he used the results of this study as well as his long years of experience working and teaching in Nigeria, to bear on editing the book. Professor Staffan Bergstrom, a Swedish obstetrician and gynaecologist, and public health expert at the Karolinska Institutet, Stockholm, Sweden has worked extensively in many parts of East Africa, especially Mozambique and Tanzania. Staffan Bergstrom is highly competent to write on maternity care in developing countries, as he has worked and written exclusively on various issues relating to the improvement of maternity care in developing countries. Thus, the personalities involved in editing this book is impressive and convinces me personally that yet again we are having a book from this stable that would stay in the mind of clinicians, teachers and students in developing countries for many years to come. The book itself was very finely finished in paperback format and with gloss pages, appropriately illustrated and well formatted in color in relevant parts. There are 26 chapters in the book, written by 22 different authors, all of who are highly experienced and known worldwide for their contributions in promoting maternal health in developing countries. For example, Professor Mahmoud Fathalla wrote an excellent piece on family planning; Alan Fleming wrote the chapters on blood transfusion facilities and HIV/AIDS along with other authors; while Robert Fraser wrote the chapter on abortion. However, Kelsey Harrison and Staffan Bergstrom wrote nearly a half of the chapters. Throughout the book the authors used a uniquely distinctive, simple but forceful language in conveying the essential messages, an approach, which makes it easy and very appealing to read. An important question that would immediately be asked about the book is: “what is new that makes it different from the earlier book written by Lawson and Stewart”? Several of the old chapters have been improved upon, to bring in new information and new knowledge. However, the most significant modification was the removal of the chapter on obstetric fistulae. Obstetric fistula in the older version of the book was described extensively, and contained sufficient information for lone operators working on the field. In this new book, obstetric fistula was discussed only as part of the chapter on obstructed labour and its sequelae, written by Chris Hudson. I suspect this to be due to the need to focus exclusively on preventive obstetrics in great detail with a heavy slant towards high maternal and perinatal mortality reduction, while laying less emphasis on core gynaecology. However, as an important cause of obstetrics morbidity in developing countries, the editors may wish to consider including more in-depth discussion of obstetric fistulae in a later edition of the book. New approaches to maternity care in developing countries have been highlighted in the book. The chapter on “difficult labour” by Chris Lennox most fittingly discussed the use of partograph for the prevention of prolonged labour in developing countries. Although the WHO identified partography as an important tool for preventing obstructed labour in developing countries in the 1980s, very little work has been done in popularizing the use of the method. No doubt, this basic description in this important textbook will increase the knowledge of clinicians and midwives about partography and their use of the method. Also, the chapter on quality and audit of maternity care by Bergstrom, and that by Kwast and Bergstrom on the training of professionals for safer motherhood are excellent pieces of work that focus on important issues relevant for optimizing maternity care in developing countries. New chapters have also been added on HIV/AIDS, childlessness and unsafe abortion, to give emphasis to the continuing importance of these problems in many developing countries. In my view, the most important issue related to maternity care in developing countries today is the prevention of the high rate of maternal mortality in these countries. Many conventional textbooks in maternity care often fail to address this problem adequately, at least not from the perspective of developing countries. One of the strongest points in favour of this new book is the clarity with which it elucidated the problem of maternal mortality in developing countries. In the opening chapter by Kelsey Harrison and Staffan Bergstrom, they described the problem of maternal mortality very vividly, especially its tenuous association with poverty, deprivation and poor organization of services. They proffer a number of solutions, the most important of which are basic education for all, improvement of the social economies of developing countries, and the training of professionals to manage obstetric complications. These recommendations address the core issues and should form the basis for policymakers and practitioners aiming to solve the problem of maternal mortality in developing countries. Overall, this book is a masterpiece, which makes important contributions to the understanding and practice of maternity care in developing countries in modern times. The book would be useful to anyone interested in maternity care and the reduction of maternal mortality in the developing world. I recommend it very highly to policymakers, undergraduate and postgraduate medical students, practicing obstetricians and gynaecologists, midwives and advocates in reproductive health. However, the publishers should make strenuous efforts to ensure affordable pricing of the book and make it available it for sale locally in developing countries. REFERENCES
Copyright 2002 - Women's Health and Action Research Centre |
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