The Policy Implications of Better Structure and Process on Birth Outcomes in Jamaica

Published in: Health Policy, v. 43, no. 1, 1998, p. 1-13

Posted on RAND.org on December 31, 1997

by John Peabody, Paul Gertler, Arleen Leibowitz

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This report finds that prenatal care in Jamaica, while generally available, provides care to many women who are at particular risk because of parity, age and poverty. Structural measures of the facilities show that clinics are in general disrepair, have only 70% of the basic equipment and are insufficiently stocked with supplies or medication. Many facilities had poor process of care, as measured by assessing the clinical examination and counseling. The average birth weight was 3232 g and 9.8% weight < 2500 g. The relationships between birth weight and the quality of care were estimated using multiple regression. The biologic and socioeconomic risk factors related to birth weight in the expected direction. None of the structural quality measures were statistically significant. Among the process measures, women who had access to a more complete examination had infants that weighed an average of 128 g more at birth. Better quality of care, provided by a more thorough clinical evaluation, has a more powerful effect on birth weight in the population than upgraded facilities or equipment. In developed or developing countries, where resources are limited, policy should focus on education and training to improve birth outcomes.

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