This study was conducted to effectiveness of service by maternity aids concerning maternal and child health in improving simultaneously infant mortality, contraception and vital registration among expectant mothers in rural Korea, where there is less apportunity for maternal and child health care.
It is unrealistic to expect to solve this problem in rural Korea through professional persons considering the situation of medical facilities and the socioeconomic condition. of residents.
So, we intended to adopt a system of services by maternity aids who were educated formally among indigenous women.
After the women were trained in maternal and child health, contraception, and registration for a short period, they were assigned as a maternity aids to each villa-ge to help with various activities concerning maternal and child health, for example, registration of pregnant women, home visiting to check for complications, supplying of delivery kits, attendance at delivery, persuasion of contraception, and invitation for registration and so on.
Mean while, four resarchers called on the maternity aids to collect materials concerning vital events, maternal child health, contraception and registration, and to give further instruction and supervision as the program proceeded.
A. Changes of women´s attitude by services of maternity aid.
Now, we examined to what extent such a service system to expectant mothers affected a change in attitude of women residing in the study area as compared to-women of the control area.
1) In the birth and death places. there were no changes between last and present infants, in study or control area.
In regard to attendants at delivery, there were no changes except for a small percentage of attendance (8%) by maternity aid in study area.
But, I expect that more maternity aids could be used as attendants at delivery if they would be trained further and if there was more explanation to the residents about such a service.
3) Considering the rate of utilization of sterilized delivery kit, I am sure that more than 90 percent would be used if the delivery kit were supplied in the proper time. There were significant differences in rates between the study and the control areas.
4) Taking into consideration the utilization rate of the clinic for prenatal care and
well baby care, if such facilities were installed, it would probably be well utilized. 5) In the contraception, the rate of approval was as high as 89 percent in study area as compared to 82 percent in the control area.
6) Considering the rate of pre-and post-partum acceptance on contraception were .as much as 70 percent or more, if motivation to use contraception was given to them adequately, the government could reach the goals for family planning as planned.
8) In the vital registration, the rate of birth registration in the study area was
some what improved compared to that of the control area, while the rate of death registration was not changed at all. Taking into account the fact that the rate of confirmation of vital events by maternity aids was remarkably high, if the registra-tion system changed to a "notification" system instead of formal registration system, it would be improved significantly compared to present system.
B. Effect of the project
Thus, with changes in the residents attitude, was there a reduction in the infant death rate?
1) It is very difficult problem to compare the mortality of infants between last and present infants, because many women don´t want to answer accurately about their dead children especially the infants that died within a few days after birth.
In this study the data of present death comes from the maternity aides who followed up every pregnancy they had recorded to see what had happened. They seem to have very reliable information on what happened in first few weeks with follow up visits to check out later changes. From these calculaton, when we compared the rate of infant death between last and present infant, there was remar-kable reduction of death rate for present infant compare to that of last children, namely, the former was 30, while the latter 42.
The figure is the lowest rate that I have ever heard. As the quality of data we could assess by comparing the causes of death.
In the current death rate by communicable disease was much lower compare to the :last child especially, tetanus cases and pneumonia.
2) Next, how many respondents used contraception after birth because of frequent contact with the maternity aid.
In the registered cases, the respondents showed a tendency to practice contraception at an earlier age and with a small number of children.
In a comparison of the rate of contraception between the study and the control area, the rate in the former was significantly higher than that of the latter. What is more, the proportion favoring smaller numbers of children and younger women rose in the study area as compared to the control area.
3) Regarding vital registration, though the rate of registration was gradually improved by efforts of maternity aid, would be better to change the registration system.
4) In the crude birth rate, the rate in the study area was 22. 2 while in the control area was 26.5. Natural increase rate showed 15. 4 in the study area, while control area was 19. 1.
5) In assessment of the efficiency of the maternity aids judging by the cost-effect viewpoint, the workers in the Medium area seemed to be more efficiency than those, of other areas.
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