The safe motherhood referral system to reduce cesarean sections and perinatal mortality - a cross-sectional study [1995-2006]

Background: In 2000, the eight Millennium Development Goals (MDGs) set targets for reducing child mortality and improving maternal health by 2015.Objective: To evaluate the results of a new education and referral system for antenatal/intrapartum care as a strategy to reduce the rates of Cesarean sections (C-sections) and maternal/perinatal mortality.Methods: Design: Cross-sectional study. Setting: Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University/UNESP, Brazil. Population: 27,387 delivering women and 27,827 offspring. Data collection: maternal and perinatal data between 1995 and 2006 at the major level III and level II hospitals in Botucatu, Brazil following initiation of a safe motherhood education and referral system. Main outcome measures: Yearly rates of C-sections, maternal (/100,000 LB) and perinatal (/1000 births) mortality rates at both hospitals. Data analysis: Simple linear regression models were adjusted to estimate the referral system's annual effects on the total number of deliveries, C-section and perinatal mortality ratios in the two hospitals. The linear regression were assessed by residual analysis (Shapiro-Wilk test) and the influence of possible conflicting observations was evaluated by a diagnostic test (Leverage), with p < 0.05.Results: Over the time period evaluated, the overall C-section rate was 37.3%, there were 30 maternal deaths (maternal mortality ratio = 109.5/100,000 LB) and 660 perinatal deaths (perinatal mortality rate = 23.7/1000 births). The C-section rate decreased from 46.5% to 23.4% at the level II hospital while remaining unchanged at the level III hospital. The perinatal mortality rate decreased from 9.71 to 1.66/1000 births and from 60.8 to 39.6/1000 births at the level II and level III hospital, respectively. Maternal mortality ratios were 16.3/100,000 LB and 185.1/100,000 LB at the level II and level III hospitals. There was a shift from direct to indirect causes of maternal mortality.Conclusions: This safe motherhood referral system was a good strategy in reducing perinatal mortality and direct causes of maternal mortality and decreasing the overall rate of C-sections.

The outlook for agriculture and rural development in the Americas: a perspective on Latin America and the Caribbean, 2009

Includes bibliography

Financing for sustainable development: visions and proposals for action from a Latin American and Caribbean perspective

Foreword Throughout the preparatory process for the World Summit on Sustainable Development and at the Summit itself, which was held in Johannesburg, South Africa, from 26 August to 4 September 2002, discussions were dominated by one central concern: the need to define and reach consensus on concrete, quantitative goals, with fixed deadlines for implementation, which were to supplement the Millennium Development Goals and facilitate progress towards an effective transition to sustainable development. Participants at the Summit explicitly affirmed the need, as a matter of urgency, to identify the financial and technical resources whereby sustainable development would become a reality and benefit directly and particularly rural and urban communities in the developing countries. The document we are now presenting is the outcome of extensive discussions held at a high-level forum during the Johannesburg Summit. Led by representatives of the Government of Mexico, the Economic Commission for Latin America and the Caribbean (ECLAC), the United Nations Development Programme (UNDP) and the Andean Development Corporation, those discussions were based on the ECLAC/UNDP study entitled Financing for sustainable development in Latin America and the Caribbean: from Monterrey to Johannesburg, which considers the opportunities and challenges for improving prospects for investment and financing for sustainable development and underscores the need to establish a new balance between the market economy and public interest through joint public/private initiatives that combine market innovation, social responsibility and appropriate regulations. Other eminent persons attending the event included heads of State, such as Gustavo Noboa, then President of Ecuador; Enrique V. Iglesias, President of the Inter-American Development Bank (IDB); José María Figueres, Managing Director of the Global Agenda of the World Economic Forum and former President of Costa Rica; and Gro Harlem Brundtland, the legendary figure who pioneered sustainable development. Valuable contributions to the discussions were made by Yolanda Kakabadse, President of the World Conservation Union; Xóchitl Gálvez Ruiz, head of the Unit for the Development of Indigenous Peoples of the Office of the President of Mexico; Cecilia López, former Minister for the Environment of Colombia; and Juan Carlos Maqueda, then Vice President of Argentina. The views emerging from the forum as set forth in this document are designed to facilitate and promote application of the Plan of Implementation of the World Summit on Sustainable Development within the framework of the Millennium Development Goals and the commitments assumed at the International Conference on Financing for Development, which was held in Monterrey, Mexico. We also aspire to continue moving forward with the adoption of measures and policies to increase investment and financing for sustainable development as well as to foster partnerships between the public and private sectors and nongovernmental organizations. We recognize, in this context, the importance of strengthening and improving public and private institutions in order to meet the operational needs associated with the effort to achieve the Millennium Development Goals and pursue the Plan of Implementation formulated in Johannesburg. We trust that this document will contribute to in-depth discussions on the application of the Plan of Implementation in the relevant forums, in particular the United Nations Commission on Sustainable Development. The Plan of Implementation of the World Summit on Sustainable Development opens up new opportunities for Latin America and the Caribbean to renew and revive their own regional agenda -with emphasis on global and especially regional public goods- and to interweave it more cohesively with the global agenda in order to promote the common interests of Latin America and the Caribbean more forcefully in international development forums. The regional agenda and the global agenda cannot be separated in a contrived manner; indeed, to an increasing degree, what we are witnessing are global environmental processes which call for action at the local level. The achievement of sustainable development in Latin America and the Caribbean, where the necessary economic, social, environmental and geopolitical conditions are combined, requires a subtle balance between the market economy, the State and the citizen. Such a balance will result in the consolidation of democratic governance in the service of human development. VICENTE FOX President of Mexico JOSÉ ANTONIO OCAMPO Executive Secretary, Economic Commission for Latin America and the Caribbean (ECLAC) ELENA MARTÍNEZ Assistant Aministrator and Regional Director for Latin America and the Caribbean of the United Nations Development Programme (UNDP) ENRIQUE GARCÍA Executive President, Andean Development Corporation (ADC)""

Meeting the millennium poverty reduction targets in Latin America and the Caribbean

Includes bibliography

Women's contribution to equality in Latin America and the Caribbean

Includes bibliography

Climate Change and Development in Latin America and the Caribbean. Overview 2009

Includes bibliography

Sustainable Development in Latin America and the Caribbean. Follow-up to the United Nations development agenda beyond 2015 and to Rio+20

Includes bibliography

The 2004 hurricanes in the Caribbean and the tsunami in the Indian Ocean: lessons and policy challenges for development and disaster reduction

Includes bibliography

Poverty, hunger and food security in Central America and Panama

Includes bibliography

Draft biennial programme of regional and international cooperation activities of the Statistical Conference of the Americas of ECLAC, 2007-2009

Includes bibliography

Montevideo consensus on population and development

Includes bibliography

Status of Implementation of the Almaty Programme of Action in South America

Includes bibliography.

UNASUR: Fostering South American integration through development and cooperation

Today, six years after the signature of its Constitutive Treaty and 14 years after the first Meeting of the Presidents of South America, the Union of South American Nations (UNASUR) stands as a union of 12 member States dedicated to the integration and long-term economic and social development of South America. With a view to achieving these aims, the Secretary-General of UNASUR has proposed three agendas: a social agenda based on the principle of inclusion, an economic agenda geared towards competitiveness and a political agenda directed towards deepening democracy and public safety. This document, UNASUR: Fostering South American integration through development and cooperation, was prepared by the Economic Commission for Latin America and the Caribbean (ECLAC) at the request of the General Secretariat of UNASUR. In follow-up to the earlier reports published in 2009 and 2011, it offers provide national authorities, academics and students, as well as the general public, an overview of some key issues on the development agenda of the nations of South America.

A study on the capacity of statistical offices of the Caribbean to produce Environment, Social, Economic and Gender Statistics

Statistical organizations of the Caribbean countries continue to face serious challenges posed by the increased demand for more relevant, accurate and timely statistical data. Tangible progress has been made in delivering key products in the area of economic statistics. The central banks of the subregion have assisted greatly in this respect. However, even in this branch of statistics there are still several glaring gaps. The situation is even worse in other areas of statistics including social and environmental statistics. Even though all countries of the subregion have committed to the Millennium Development Goals (MDGs) as well as to other internationally agreed development goals serious challenges remain with respect to the compilation of the agreed indicators to assist in assessing progress towards the goals. It is acknowledged that appreciable assistance has been provided by the various donor agencies to develop statistical competence. This assistance has translated into the many gains that have been made. However, the national statistical organizations require much more help if they are to reach the plateau of self reliance in the production of the necessary statistical services. The governments of the subregion have also committed to invest more in statistical development and in promoting a statistics culture in the Caribbean. The training institutions of the subregion have also started to address this urgent need by broadening and deepening their teaching curricula. Funding support is urgently required to develop the appropriate cadre of statistical professionals to deliver the required outputs. However, this training must be continuous and must be sustained over an appropriate period since the current turnover of trained staff is high. This programme of training will need to be intensive for a period of at least five years after which it may be reduced. The modalities of training will also have to be more focused and in addition to formal training at educational institutions there is much room for on-the-job training, group training at the national level and much more south-south capacity building. There is also an urgent need to strengthen cooperation and collaboration among the donor community in the delivery of assistance for statistical development. Several development agencies with very good intentions are currently operating in the Caribbean. There is a danger however, that efforts can be duplicated if agencies do not collaborate adequately. Development agencies therefore need to consult with each other much more and share there development agenda more freely if duplication is to be averted. Moreover, the pooling of resources can surely maximize the benefits to the countries of the subregion.

Knowledge Management for Development: Towards a Practical Approach for the Caribbean

This report proposes a framework for locating, collecting, creating, sharing and applying information and knowledge (from within and outside the subregion) for development purposes in the Caribbean subregion. The framework emphasizes the importance of protecting and tapping into the rich cultural heritage and traditional knowledge of the Caribbean to support its development. This knowledge management for development framework, advanced by ECLAC, is proposed for consideration in the design and implementation of both national policies and strategies, and communitylevel projects to support the achievement of the Millennium Development Goals and the overall sustainable development of the Caribbean subregion. It considers six main elements, namely inputs, processes and tools, outputs, pillars (on which all the above are built on), the environment or context in which this, like any other scheme, operates and the monitoring and evaluation of knowledge management initiatives. The approach draws from examples of models, frameworks and initiatives developed worldwide, with particular emphasis on those from Latin America and the Caribbean.