Immpact Toolkit: Module 4
Version 2
Outcomes after Pregnancy (OAP)
Safe motherhood programmes focus on reducing maternal mortality in developing countries. Most of these deaths are caused by the inadequate care of severe complications during pregnancy, delivery or relating to unsafe abortion. Restricting the focus to maternal mortality, however, seriously underestimates the burden of disease attributable to pregnancy-related causes. For every woman who dies, at least ten survive severe obstetric complications and unsafe abortions, with potentially disabling consequences which are rarely considered.
These consequences, which we have termed 'outcomes after pregnancy' (OAP), comprise diagnosed and perceived illness or disability following pregnancy (including mental illness) and direct social and economic consequences of events related to pregnancy. Attention to these outcomes, combined with information on maternal death and acute obstetric complications, creates a more holistic and longer-term perspective on maternal health.
Public health research in developed countries has moved beyond the evaluation of 'hard' physical outcomes, such as diagnoses or deaths, and utilizes self-perceived 'health status' or even 'health-related quality of life' indicators to complement the evaluation of interventions. These findings can be useful in many ways, for example as a way to assess different programmatic options or for resource allocation. In resource-poor contexts, where public health programmes are struggling against high levels of maternal mortality, it could be argued that any other health-related considerations in relation to pregnancy are unaffordable luxuries. But by focusing on the reduction of maternal mortality as the sole benchmark for progress, programmes ignore inadvertent but undesirable effects or consequences that they may need to address.