CHILDBIRTH IN RURAL-AREAS - MATERNAL DEATHS, VILLAGE DELIVERIES AND OBSTETRIC SERVICE USE

We explored village maternal deaths in an area of the East Sepik Provi nce of Papua New Guinea where most women delivered at home, Postpartum haemorrhage, retained placenta and puerperal sepsis were common cause s of death. Follow-up of a group of pregnant women showed that abnorma l labour was frequent, 24% of multigravidae (95% CI 17-33) reported a labour that lasted longer than 24 hours. In 9% of all births (95% CI 5 -15) the third stage lasted longer than one hour, or products were ret ained, Despite a high proportion of obstetric complications in apparen tly low-risk villages births, few women attend a health facility for d elivery. Health centre attenders were a relatively privileged group. S ome hospital users complained about staff attitudes. A poor reputation means that women are less likely to use health services for delivery. Providers need to improve the acceptability of the care provided, and communities should be encouraged to help with transport for their wom en to go to a health facility when they are in labour.