Safe motherhood : development and women's health in childbirth, Binh Dinh province, Viet Nam : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Philosophy of Development Studies, Massey University, New Zealand

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Safe Motherhood is one of the most important aspects of women's health, and is crucial to the development of a country. Women can only contribute to the economic, political, social and cultural development of their country if they are well and healthy. This thesis reviews the literature on poverty, health and development to examine factors which contribute to this major global issue. One of the eight United Nations Millennium Development Goals is to reduce maternal mortality by three quarters by the year 2015. Maternal mortality is the major cause of death among women of childbearing age in the developing world, with the World Health Organisation estimating that 600,000 women a year die as a result of pregnancy and childbirth (Levine et al., 2004; Thompson, 1999). Most of the deaths (99%) occur in developing countries and 80% of them are preventable, even in resource-poor countries (Lewis, 2003). The major direct cause of maternal mortality is haemorrhage at birth; if haemorrhage was reduced it would contribute significantly to reduction of maternal mortality (Wagstaff & Claeson, 2004). In this research project the author worked with the Binh Dinh Provincial Department of Health to develop a more complete picture of the problem of haemorrhage in one rural province of Viet Nam. Ethnic minority women are among the poorest and most disadvantaged in the community. In this research they were shown to receive the least amount of preventative antenatal health care, and to be at greatest risk of haemorrhage. The single greatest health factor shown to reduce maternal mortality is to have a skilled attendant at every birth who can prevent or detect problems early, and treat emergencies such as haemorrhage (Levine et al., 2004; World Bank, 2003; de Bernis et al., 2003; Kwast et al., 2003; Peters, 2000). In the second branch of the research, detailed observations were made of the technical skills of maternity staff to assess areas which could be improved through training programmes. These training programmes will enable the midwives to be better skilled and to provide safer care. Recommendations from the research include that the Department of Health invest in strengthening basic training, and ongoing postgraduate in-service education, in specific technical areas of monitoring and treating haemorrhage; that logistical support and supplies be improved so that all centres have the necessary equipment and medications to be able to prevent and treat haemorrhage; and that the Department of Health apply to the Ministry of Health for permission to teach their staff a specific haemorrhage prevention management approach called Active Management of the third stage of labour. Midwives in the province are eager for training and improved skills, and with the Department's support in these matters outlined above, they can achieve their desire of providing the best care they can to women in their communities. Improving the technical skills of midwives is one important aspect of addressing the problem of maternal mortality. However other underlying causes are complex and include poverty and the low status of women in society; these aspects will be more difficult to overcome. Safe Motherhood is a right; women in every country should be able to expect to survive the natural process of childbirth. It will take a multi-layered approach to overcome this complex problem and allow women to be safe in childbirth.
Childbirth, Vietnam Maternal health services, Midwives, Mortality Mothers