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Lamia Ayaz
14 January 2022
GT Independent Research
Annotated Source List

American College of Obstetrics and Gynecology. (2021, December). Preeclampsia and high
blood pressure during pregnancy. Retrieved January 13, 2022, from
https://www.acog.org/womens-health/faqs/preeclampsia-and-high-blood-pressure-during-
pregnancy

This source describes information on preeclampsia and hypertensive disorders

during pregnancy. Preeclampsia is an organ system disease that usually develops after 20
weeks of pregnancy. Symptoms include high blood pressure, swelling of face and hands,
constant headache, and vision changes. Untreated, it can cause seizures and stroke, as
well as HELLP syndrome. Oftentimes, babies will be delivered early in order to
maximize chances of survival for both mother and child. Risk factors include carrying
multiple fetuses, chronic hypertension, diabetes mellitus, autoimmune disorders, and a
BMI over 30.
This source describes a major component of maternal mortality: untreated
preeclampsia, which leads to eclampsia. The article provides needed background
information on preeclampsia so that deeper research can be done later on treatments
plausible in underdeveloped areas. The information is easy to understand because it is
intended for a general audience, but this may mean that there are some
oversimplifications. Additionally, there is no works cited provided. However, the
information is from an extremely reputable source: The American College of Obstetrics
and Gynecology, a leading institution for maternal health. Further, no bias could be
detected.

Chmielewska, B., Barratt, I., Townsend, R., Kalafat, E., Van der meulen, J., Gurol-Urganci, I.,
O'brien, P., Morris, E., Draycott, T., Thangaratinam, S., Le Doare, K., Ladhani, S., Von
Dadelszen, P., Magee, L., & Khalil, A. (2021). Effects of the covid-19 pandemic on
maternal and perinatal outcomes: A systematic review and meta-analysis. The Lancet
Global Health, 9(6), e759-e772. https://doi.org/10.1016/S2214-109X(21)00079-6

This journal article entails a systematic review and meta-analysis of existing

literature on the COVID-19 pandemic and its relation to maternal and infant outcomes.
Overall, the authors discover that the pandemic has caused increased still-births, maternal
deaths, surgically-managed ectopic pregnancies, and postpartum depression. This is
related to the disruption of healthcare services due to lockdowns, maternal anxiety,
increased maternal burdens, and reduced maternity ward staffing. These effects are
especially exacerbated for mothers in low-income countries, who are already
socioeconomically disadvantaged and do not have access to telehealth or other means of
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continued health care. Overall, the source describes a need for better maternal, fetal, and
perinatal pathways and reduced healthcare disparities.

This source is relevant due to its discussion of COVID-19 and its impact on
maternal mortality. Many journal articles and studies currently available were published
before the pandemic, thus not taking into account the significant impacts COVID has had
on maternal health. Knowing that maternal outcomes have worsened since many figures
have been recorded is a critical addendum to add to any part of the research process. This
source is an excellent springboard into further research into impacts of COVID-19 on
maternal mortality, and it may be used to write interview questions about the current state
of maternal health. The source is extremely reputable, with study bias and contradictory
results extensively discussed and analyzed. The meta-analysis itself contains no
detectable bias.

Conceição, P. (2020). The next frontier: Human development and the anthropocene (Human
Development Report). United Nations Development Programme.
http://hdr.undp.org/sites/default/files/hdr2020.pdf

This source is a report on Human Development provided by the United Nations.

The most relevant information is about the Inequality-Adjusted Human Development
Index (IHDI). The Human Development Index (HDI) is a statistic created by the United
Nations that factors in life expectancy at birth, expected years of schooling, mean years
of schooling, and gross national income per capita to create a composite number
reflective of the level of development in a country. The IHDI takes into account
inequality within a country and incorporates how it affects the HDI. This report provides
a table of the countries ranked by IHDI, and it also groups them into very high
development, high human development, medium human development, and low human
development countries.

This source is relevant because a technical definition for which countries are
"developing" is needed for this project, and the report's list of countries with low and
medium human development is likely going to serve as that definition. This definition
will be present in the background paragraphs of the research proposal and the final
project, as well as any other products in between. The IHDI is an especially worthwhile
measure in terms of maternal mortality because life expectancy (which indicates quality
of life and healthcare), education, and economic status all greatly influence maternal
health. Further, the IHDI factors in the considerable impact of inequality on maternal
mortality; within the same country, one woman can have access to the highest standards
of healthcare, and the other can be given birth at home without any medical care. The
report itself is extremely well-researched, and the United Nations is a reputable source.
There is no detectable bias.
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Daff, B. M., Seck, C., Belkhayat, H., & Sutton, P. (2012). Informed push distribution of
contraceptives in Senegal reduces stockouts and improves quality of family planning
services. Global Health: Science and Practice, 2(2), 245-252.
https://doi.org/10.9745/GHSP-D-13-00171

This source highlights a distribution plan to reduce stockouts of contraceptives in

Senegal. Contraceptive usage in Senegal has been exceedingly low in recent years, and
public health facilities, where most women get contraceptives, often experience
stockouts. This causes women to have to switch contraceptives, discontinue use, or buy
from the more expensive private sector. Rather than the less-effective pull-based
distribution model, a push-based distribution model was developed and piloted from
February 2012 to July 2012. Key features of this system included a logistician that
managed deliveries and stock and at least a two-month supply at every facility. Stockouts
were reduced from being common to being almost completely eliminated. Further, since
a logistician was managing stock, clinicians had more time to deal with patients. This
article describes an important way to streamline contraception access and improve
healthcare services.

This source is relevant since it discusses a method to improve contraception

access. When women have access to effective contraception on a regular basis, the risk of
unintended pregnancies is greatly reduced. Thus, they are less likely to die during
pregnancy and childbirth. This information may be included in a prong about plans to
improve contraceptive access. More research needs to be done to see if other countries
have similar issues with public sector contraceptive stockouts, or if this is a uniquely
Sub-Saharan African problem. The article is organized in a way that is slightly difficult to
understand, but the language is simple. There is no significant bias. Overall, the source is
beneficial in providing a clearly defined method to improve contraception access, rather
than a general overview.

Demisse, G. A., Sifer, S. D., Kedir, B., Fekene, D. B., & Bulto, G. A. (2019, March 18).
Determinants of puerperal sepsis among postpartum women at public hospitals in west
SHOA zone Oromia regional state, Ethiopia (institution basedcase control study). BMC
Pregnancy and Childbirth. Retrieved January 13, 2022, from
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2230-x#

This study describes the risk factors for puerperal sepsis in postpartum women in
Ethiopia. Puerperal sepsis is the infection of the genital tract and occuring at any time
from delivery to 42 days postpartum. Symptoms include pelvic pain, high body
temperature, and abnormal vaginal discharge. Living in a rural area may increase risk of
puerperal sepsis, especially due to poor sanitation, unclean home deliveries, and a lack of
medical care. Women with lower incomes and with poorer education were more likely to
develop puerperal sepsis, as well as women who were in labor for more than 24 hours.
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Lastly, women who had a Cesarean-section or who experienced 5 or more vaginal

manipulations during delivery were at higher risk.

This source is relevant because it identifies risk factors for puerperal sepsis, and
infection is one of the most significant causes of maternal mortality in developing
countries. Information on the risk of vaginal manipulation, for example, can be used to
guide local midwives on how to minimize mortality rate. This is one of the most recent
and relevant studies published on this topic. However, it did contain grammatical errors,
some of which interfered with comprehension. It is likely that these errors are likely a
result of poorer English comprehension or subpar editing, rather than a lack of
knowledge on the topic. No bias could be detected.

Hodin, S. (2017, September 26). World contraception day: How does family planning impact
maternal health? Maternal Health Task Force at the Harvard Chan School.
https://www.mhtf.org/2017/09/26/world-contraception-day-how-does-family-planning-im
pact-maternal-health/

This blog post discusses the significance of family planning, or the ability for a
woman to choose when or if to have a pregnancy and whether to carry that pregnancy to
term. There are two main family planning options: contraception and abortion. In 2008,
contraceptive usage prevented 44% of maternal deaths; this occurred through a reduction
of total births, high-risk births, and unsafe abortions. Unmet need for contraception is still
relatively high in many areas, and integrating postpartum family planning into antenatal
care could be a critical solution.

This article's information is relevant because it discusses the relationship between

contraception and maternal death, which is the basis of the hypothesis for this project.
The article also links to multiple journal articles about contraceptive usage and maternal
death, serving as an excellent springboard for further background research. It is concise
and relatively reputable, having been written by the National Senior Manager of Maternal
Newborn Health Programs at Steward Health Care under a Harvard task force's blog. No
bias could be detected.

Hoke, T., Brunie, A., Krueger, K., Dreisbach, C., Akol, A., Rabenja, N. L., Olawo, A., &
Stanback, J. (2012). Community-based distribution of injectable contraceptives:
Introduction strategies in four Sub-Saharan African countries. International Perspectives
on Sexual and Reproductive Health, 38(4), 214–219.
http://www.jstor.org/stable/23343639

This source describes the importance of allowing community health workers to

distribute injectable contraception in Sub-Saharan Africa. Although injectables are the
most popular contraceptive method in this region, community health workers in the past
were often not permitted to administer them; they could only distribute birth control pills
and condoms. This was due to fears of improper technique. In the late 2000s, however,
the sentiment among experts began to shift. Soon after, Nigeria, Kenya, Uganda, and
Madagascar created distribution plans that allowed community workers to administer
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injectables. This source summarizes the results. Researchers found that contraceptive
usage increased dramatically, and women were just as satisfied receiving the injectable
from a health worker as from a clinician.

This article's information is relevant because it focuses on contraception, and

contraception decreases pregnancy rates and thus maternal mortality. More research
needs to be done on reasons behind implant popularity in Sub-Saharan Africa, as well as
ways to distribute contraceptives in countries without already-substantial distribution
programs. The article is clear and well-organized, and no bias could be detected. This
source will be beneficial in creating a potential program for contraceptive distribution.

Kes, A., Ogwang, S., Pande, R.P. et al. The economic burden of maternal mortality on
households: evidence from three sub-counties in rural western Kenya. Reprod Health 12,
S3 (2015). https://doi.org/10.1186/1742-4755-12-S1-S3

This study describes the economic effects of maternal mortality on households in

rural Kenya between September 2011 and March 2013, utilizing both control and case
groups. The researchers detail that the families of women who are sick and eventually die
spend about one-third of their per capita consumption expenditure on healthcare.
Furthermore, in order to pay funeral costs, many families have to borrow money from
friends and family or sell assets. When a woman dies, household structures have to be
reorganized as well. Mothers, mother-in-laws, and husbands attempt to do housework and
care for children while simultaneously making up for the loss of productive labor.

This article's information is relevant because it discusses a rarely-considered

effect of maternal mortality: financial difficulty. This information will be utilized in the
background paragraph of the research proposal to describe the extent of maternal
mortality as a global health issue. The study has an excellent literature review and
contains no detectable bias. However, it is dated and the financial figures may not be
completely accurate due to inflation and pandemic changes.

Latt, S. M., Milner, A., & Kavanagh, A. (2019). Abortion laws reform may reduce maternal
mortality: An ecological study in 162 countries. BMC Women's Health.
https://doi.org/10.1186/s12905-018-0705-y

This source describes the relationship between abortion flexibility and maternal
health in 162 different countries. The study lists seven circumstances in which abortions
are performed, such as fetal impairment or to save the mother's life. Flexibility scores are
assigned based on the number of circumstances for which abortion is legal. The study
determines that, in countries with more flexible laws, maternal health is better. This may
be due to reductions in unsafe abortions and in the Total Fertility Rate. The authors voice
that reforming strict abortion laws to be more flexible will better maternal health.

This article is relevant due to its discussion of a method to reduce maternal

mortality. Abortion reform may be used as a prong since the authors identify a notable
correlation between abortion access and maternal health. More research into studies
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establishing causation is needed first, however. The source also provides a wealth of
specific data, such as statistics for maternal mortality and reasons for abortion across
nations, and the works cited is as an excellent springboard for further research on
pregnancy and abortion. Additionally, the article is not biased; in no way do the authors
suggest that they are in morally in support of or against abortion, and they also adjust for
confounds. As a whole, this journal article is strong and encompasses needed information
about the impacts of abortion laws.

Management Sciences Health. (n.d.). South Asia: Regional perspectives on challenges and
opportunities:. https://www.msh.org/sites/default/files/miso_sa_map.pdf

This report summarizes the results of a 2011 study with women's health
organizations in South Asia on misoprostol usage. It discusses the incidence of
postpartum hemorrhage in the region, and it then provides reasoning for combating
postpartum hemorrhage with misoprostol specifically. The source also entails the barriers
to misoprostol usage and ways they can be addressed. Overall, this article describes
important aspects of maternal mortality cause and reduction.

This source is valuable, serving as a starting point in understanding misoprostol's

role in reducing maternal mortality. It is especially beneficial in that it is one of few
sources that focuses entirely on South Asia. The report also provides excellent statistics,
and it is a brief and easy read. However, further research into the benefits of misoprostol
versus oxytocin, as well as strategies to combat the barriers to misoprostol, is needed.
Additionally, it may be helpful to review the original research report to ensure that the
organizations that provided the information were qualified to do so.

Peters, D. H., Garg, A., Bloom, G., Walker, D. G., Brieger, W. R., & Hafizur Rahman, M. (2008).
Poverty and access to health care in developing countries. Annals of the New York
Academy of Sciences, 1136(1), 161-171. https://doi.org/10.1196/annals.1425.011

This journal article describes the relationship between poverty and healthcare
access. People living in poor countries face significant barriers to healthcare access, and
these barriers are most pronounced among the impoverished in poor countries. Firstly,
there are issues with geographic accessibility. In many areas, it is difficult to transport
people and supplies to clinics due to poor conditions and long travel times. Another
barrier is availability: limited operating hours, long wait times, absentee healthcare
workers, and a lack of drug stock drive people to seek traditional healthcare or healthcare
farther away. Financial constraints are common as well. Poverty restricts access to
healthcare, but this leads to even poorer health and a loss of productivity, which again
leads to poverty in an endless cycle. Even if people are able to access healthcare, they
may go into distress-spending in order to pay for transportation, food, lodging, and care.
Lastly, there are social barriers regarding acceptability. Many public clinics, when
contrasted to village medicinemen, do not have a strong understanding of social and
cultural norms.
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This source is relevant because it discusses barriers to healthcare for the

impoverished in developing countries, and a large portion of maternal mortality takes
place because women do not have access to adequate healthcare. Using information about
barriers, a proposal plan for healthcare reform can be formulated to improve access to
both contraception and also general maternal care. This source is somewhat outdated
since it is from 2008, but the general premise of the work still applies. No bias could be
detected.

Psychiatry Department. (2018, November 16). In longest and most detailed study of pediatric
grief following parental loss to date, department researchers find increased rates of
depression and functional impairment. University of Pittsburgh. Retrieved November 18,
2021, from
https://www.psychiatry.pitt.edu/news/longest-and-most-detailed-study-pediatric-grief-foll
owing-parental-loss-date-department

This source describes the findings of studies on mental health impacts of parental
loss in children. It discusses that, in children, the loss of a parent leads to higher rates of
depression and functional impairment at school and at home. Furthermore, people who
lose their parents at young ages are more likely to experience depression than those who
lose a parent during adolescence. Regardless, parental death correlates with higher rates
of post-traumatic stress disorder, as well as increased vulnerability to future negative
events.

This article is critical because it details an effect of maternal mortality that is

often not considered. This information will likely be incorporated into a background
paragraph discussing the many detriments of maternal mortality. This article has no
detectable bias and cites its sources, but it is not a professional-grade article and
information must be corroborated. It is organized and serves as a great launchpad for
future research into the effects of maternal mortality on children's health.

Shidhaye, P., & Giri, P. (2014). Maternal depression: A hidden burden in developing countries.
Ann Med Health Sci Res, 4(4), 463-465. https://doi.org/10.4103/2141-9248.139268

This journal article describes the impact of maternal depression in developing

countries, also including information on risk factors and potential treatments. It highlights
that maternal depression may be more common in developing countries than developed
countries, yet resources for prevention, screening, and treatment are not sufficient. This is
despite the fact that depression can take a toll on both a mother's health and children's
health. In terms of prevention, universal screening is ideal, but it is not possible in
resource-constrained areas. However, the source describes community health workers as
important partners in delivering basic mental health treatment to areas without substantial
healthcare. Maternal depression is both preventable and treatable, but communities need
funds and investments to do so.

The source is relevant due to its discussion of maternal depression, which can
lead to suicide. This is categorized under maternal mortality. The article is especially
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important because it is one of few sources that discusses the mental health aspect of
maternal mortality; most of the time, only physical health is discussed. This article was
easy to read and contained no detectable bias. It will serve as a springboard into further
research into maternal mental health. Furthermore, although suicide does not make up a
large portion of maternal mortality cases, it may be used within a prong. The source
heavily describes the potential benefit of using lay community workers to administer
mental health treatment, which overlaps with other sources discussing the benefits of
community health workers in distributing contraception. Thus, community health
workers will likely be featured in the creation of a program to reduce maternal mortality.

Stevens, H., & Huys, I. (2017). Innovative approaches to increase access to medicines in
developing countries. Frontiers in Medicine, 4. https://doi.org/10.3389/fmed.2017.00218

This article discusses how various public health approaches affect the production
and availability of drugs. In developing countries, a large portion of people struggle to
access medications. Although lack of infrastructure is a major cause, so is excessive cost.
The source details multiple ways to decrease drug prices. Governments can issue
compulsory licenses or patent pools, which allows patent-protected technology to be
utilized by outside companies for public health reasons. This reduces prices by creating
competition in the drug market. Pharmaceutical companies can also implement tiered
pricing, where medication prices are set lower in developing countries than in developed
countries. Lastly, enabling public-private partnerships, or partnerships between
government bodies and pharmaceutical companies, can have significant impacts; these
partnerships better medication distribution and technology transfer. Each method has both
benefits and detriments that are elaborated on in the source and must be considered.

Overall, a major cause of maternal mortality is a lack of access to contraception

and drugs to treat infections. Thus, increasing access to critical drugs should reduce
maternal mortality. This source did not appear to have significant bias, but it was quite
difficult to understand due to its usage of public health and pharmaceutical jargon.
Regardless, it will be useful in discussing ways to increase healthcare access, especially
since it connects to earlier sources.

World Health Organization. (2019, September 19). Maternal mortality [Fact sheet]. Retrieved
November 14, 2021, from
https://www.who.int/news-room/fact-sheets/detail/maternal-mortality

This source is a spreadsheet containing extensive raw data about health indicators
across every country of the world. It includes maternal mortality rates, the proportion of
births attended by skilled birth attendants, density of medical doctors per 10,000 people,
and density of midwives and nursing personnel per 10,000 people. Additionally, there are
statistics for the proportion of women who have their contraceptive needs met, malaria
incidence, domestic violence rates, suicide mortality rate, and adolescent birth rate.

Overall, this source is relevant since it gives tangible numbers to the prongs being
studied, such as contraceptive distribution and risk factors for postpartum depression. In
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papers and presentations, it will be very helpful to give a statistic to support an idea. This
is especially significant since the data is from a 2021 report and may consider the impact
that the pandemic has had on global health. The information comes from a reputable
group, the World Health Organization, and there is no detectable bias. The spreadsheet is
hard to navigate and the raw data is not useful on its own, so there will need to be
considerable data interpretation.

World Health Organization. (2021, May 19). Country, WHO region and global statistics.
Retrieved November 3, 2021, from
https://cdn.who.int/media/docs/default-source/gho-documents/world-health-statistic-repo
rts/2021/whs2021_annex2_20210519.xlsx?sfvrsn=7f635c31_5

This source is a report on Human Development provided by the United Nations.

The most relevant information is about the Inequality-Adjusted Human Development
Index (IHDI). The Human Development Index (HDI) is a statistic created by the United
Nations that factors in life expectancy at birth, expected years of schooling, mean years
of schooling, and gross national income per capita to create a composite number
reflective of the level of development in a country. The IHDI takes into account
inequality within a country and incorporates how it affects the HDI. This report provides
a table of the countries ranked by IHDI, and it also groups them into very high
development, high human development, medium human development, and low human
development countries.

This source is relevant because a technical definition for which countries are
"developing" is needed for this project, and the report's list of countries with low and
medium human development is likely going to serve as that definition. This definition
will be present in the background paragraphs of the research proposal and the final
project, as well as any other products in between. The IHDI is an especially worthwhile
measure in terms of maternal mortality because life expectancy (which indicates quality
of life and healthcare), education, and economic status all greatly influence maternal
health. Further, the IHDI factors in the considerable impact of inequality on maternal
mortality; within the same country, one woman can have access to the highest standards
of healthcare, and the other can be given birth at home without any medical care. The
report itself is extremely well-researched, and the United Nations is a reputable source.
There is no detectable bias.