DETERMINANTS OF PREGNANCY OUTCOMES AND TARGETING OF MATERNAL HEALTH-SERVICES IN JAMAICA

Detailed nationally representative population level data were used to investigate the pre-natal care and delivery experiences of pregnant wo men in Jamaica. The results of this study show that : (a) demographic criteria (particularly first births) and self-reported clinical pregna ncy complications are valid predictors of deleterious maternal health outcomes and can be used to stratify mothers into risk groups. (b) The re appears to be a significant problem of under and inappropriate util ization of pre-natal care services by all women and in particular by d emographically 'high risk' women, i.e. young, first time mothers. Sign ificant proportions of the latter group report either no pre-natal car e visits at all or visits which are later than the first trimester. Th e problems of delayed initiation of pre-natal care are specially exace rbated for poor, teenage mothers who happen to be living in the Kingst on Metropolitan Area. (c) In terms of the content and quality of pre-n atal care services the message is somewhat mixed. On the positive side the pre-natal care system is doing a moderately satisfactory job with regard to diagnostic tests and educational advice. On the negative si de however, the fact that once women enter the health care system they all receive the same moderately adequate care (in terms of diagnostic evaluations and educational advice) with no attempt to focus particul ar attention on high risk mothers is troublesome. (d) With regard to a ppropriate delivery venues for pregnant women, pre-natal care visits d o not appear to significantly influence the choice of delivery venues. Moreover, rich urban women are much more likely to deliver in a hospi tal than their rural peers. In conclusion, the study discusses the soc ial and behavioral context of these results, addresses the policy impl ications and makes some recommendations to improve maternal health ser vices.