Abstract

PIP: The potential efficacy of preventive interventions in Latin America to reduce perinatal morbidity and mortality is reviewed. The most important perinatal risk factors associated with pregnancy and delivery are young age of the mother, low socioeconomic status, low education, malnutrition, lack of prenatal care, pregnancy-induced-hypertension, perinatal infections, alcohol, smoking, and iatrogenic causes. Adequate data are lacking to determine the magnitude of these factors in Latin America. Iatrogenic causes of perinatal morbidity are increasing because of the tendency to institute neonatal intensive care before improvement in medical and nursing staff and procedures. Specific programs that have been effective include the 30-year effort in Chile to reduce the incidence of low birth weight. Infant death rates in Latin America fell between those in Asia and the West, correlated with the occurrence of low birth weights. Nutritional programs are mixed in their effect: they do not necessarily help unless targeted at women with clinical malnutrition or history of LBW or IUGR; they can harm overall food production in the community. Increasing institutionalization of labor and delivery is a mixed blessing. Efforts in Guatemala to reverse the worst aspects of hospital delivery have improved pregnancy and labor outcomes. These include permitting fathers to attend births, allowing women to deliver in kneeling position, and encouraging infant bonding and breast feeding. Other effective interventions include mothers meetings to encourage prenatal care, and detection and referral of high risk cases in a regionalized system of care.