Introduction
Recently, changes in the patterns and concepts of maternity care, in both developing and developed countries have been accelerating. An outstanding ; development in this field, is the number of deliveries taking place in hospitals or maternity centers. In Korea, however, more than 90% of deliveries are carried out at home with the help of untrained relatives or even without helpers. It is estimated that less than 10% of deliveries are assisted by professional persons such as a physician or a midwife.
Taking into account the shortage of professional person in rural Korea, it is difficult to expect widespread prenatal, postnatal, and delivery care by professional persons in the near future. It is unrealistic, therefore, to expect rapid development of MCH care by professional persons in rural Korea due to economic and sociological reasons. Given these conditions, it is reasonable that an educated village women could used as a "maternity aid", serving simple and technically easy roles in the MCH field, if we could give such a women incentive to do so.
The midwife and physician are assigned difficult problems in the MCH field which could not be solved by the village worker. However, with the application of the village worker system, we could expect to improve maternal and child health through the replacement of untrained relatives as birth attendants with educated and trained maternity aides.
We hope that this system will be a way of improving MCH care, which is only one part of the general health services offered at the local health center level.
Problems of MCH in rural Korea
The field of MCH is not only the weakest point in the medical field in our country but it has also dropped behind other developing countries. Regarding the knowledge about pregnancy and delivery, a large- proportion, of our respondents reported having only a little knowledge, while 29% reported that they had "sufficient" knowledge.
The average number of pregnancies among women residing in rural areas was 4.3 while the rate of women with 5 or more pregnancies among general women and women who terminated childbearing were 43 and 80% respectively. The rate of unwanted pregnancy among general women was 19.7%. The total rate for complications during pregnancy was 15.4%, toxemia being the major complication. The rate of pregnant women with chronic disease was 7%.
Regarding the interval of pregnancy, the rates of pregnancy within 12 months and within 36 months after last delivery were 9 and 49% respectively. Induced abortion has been increasing in rural areas, being as high as 30-50% in some locations. The maternal death rate was shown 10 times higher than in developed countries (35/10, 000 live births).
Prenatal care
Most women had no consultation with a physician during the prenatal period. Of those women who did have prenatal care, the majority (63%) received such care only 1 or 2 times throughout the entire period of pregnancy. Also, in 80% of these women the first visit came after 4 months of gestation.
Delivery conditions
This field is lagging behind other public health problems in our country. Namely, more than 95% of the women delivered their baby at home, and delivery attendance by a professional person occurred only 11% of the time. Attendance rate by lay men was 73%, while those receiving no care at all was 16
For instruments used to cut the umbilical cord, sterilized scissors were used by 19%, non-sterilized scissors by 63% and 16% used sickles. Regarding delivery sheets, the rate of use of clean sheets was only 10%, unclean sheets, vinyl and papers 72%, and without sheets, 18%.
The main reason for not using a hospital as a place of delivery was that the women felt they did not need it as they had previously experience easy deliveries outside hospitals. Difficult delivery composed about 5% of the total.
Child health
The main food for infants (95%) was breast milk. Regarding weaning time, the rates within one year, up to one and half, two, three and more than three years were 28, 43, 60, 81 and 91% respectively, and even after the next pregnancy still continued lactation.
The vaccination of children is the only service for child health in rural Korea. As shown in the Table, the rates of all kinds of vaccination were-very low and insufficient.
Infant death rate. was 42 per 1,000 live births. Most of the deaths were caused by preventable diseases. Death of infants within the neonatal period was 83% meaning that deaths from communicable diseases decreased remarkably after that time. Infant deaths which occurred without medical care was 52%.
Methods of improvement in the MCH field
1. Through the activities of village health workers(VHW) to detect pregnant women by home visiting and after registration, visiting once a month to observe any abnormalities in pregnant women. If they find warning signs of abnormalities, they refer them to the public health nurse or midwife.
Sterilized delivery kits were distributed to the expected mother 2 weeks prior to expected date of delivery by the VHW. If a delivery was expected to be difficult, then the VHW took the mother to a physician or call a physician to help after birth, the VHW visits the mother and baby to confirm health and to recommend the baby be given proper vaccination.
2. Through the midwife or public health nurse (aid nurse)
Examination of pregnant women who are referred by the VHW to confirm abnormalities and to treat them. If the midwife or aid nurse could not solve the problems, they refer the pregnant women to the OB-GY specialist. The midwife and PHN will attend in the cases of normal deliveries and they help in the birth. The PHN will conduct vaccination for all infants and children under 5, years old.
3. The Physician will help only in those cases referred to him by the PHN or VHW. However, the physician should examine all pregnant women at least three times during their pregnancy.
First, the physician will identify the pregnancy and conduct general physical examination to confirm any chronic . disease that might disturb the continuity of the pregnancy.
Second, if the pregnant woman shows any abnormalities the physician must examine and treat.
Third, at 9 or 10 months of gestation (after sitting of the baby) the physician should examine the position of the fetus and measure the pelvis to recommend institutional delivery of those who are expected to have a difficult delivery. And of course, the medical care of both the mother and the infants are responsible of the physician.
Overall, large areas of the field of MCH would be served by the VHW, PHN, or midwife so the physician is needed only as a part-time worker.
1. Maternal Health A. Pregnancy
1. Knowledge about pregnancy and delivery: Rate of women with nothing or a little but not sure 67%
Source of information about pregnancy and delivery; Mother or mother-in-law 68%
2. Number of pregnancy
Average No. of pregnancy of women residing in the area; 4.3 times
Rate of women who have experienced 5 or more times of preg 43%
Rate of women who have experienced 5 or more pregnancy among women who passing the age of bearing 80%
Rate of unwanted pregnancy 19.7%
3. Complication during pregnancy 15.4%
Hemorrhage 1.8
Toxemia 8.2
Others 5.4
Chronic diseases during pregnancy 7.0% Chronic gastro-intestinal disease 28%
Heart disease 8
Nephritis 4
Pulmonary tuberculosis 4
Communicable disease 10
Other chronic disease 14
U. K 32
4. Interval between pregnancy;
Within 12-24 months 9.0%
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