Ana Pilar Betran
Dados Biográficos
| ID | 6060367 |
|---|---|
| NOME | Ana Pilar Betran |
| PRENOMES | Ana Pilar |
| SOBRENOME | Betran |
| ASSINATURA | BETRAN A P |
| AFILIAÇÕES | World Health Organization |
| ORCID | 0000-0002-5631-5883 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 23 |
| TOTAL DE CITAÇÕES | 4 |
| TOTAL COMO AUTOR | 23 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2006 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 1 |
Implementation of a decision aid to promote shared decision-making on mode of birth in low-risk pregnant women
INTRODUCTION: Implementing shared decision-making (SDM) in maternity care remains challenging in low-income and middle-income countries (LMICs). Decision aids can support SDM, but evidence on their effectiveness in such settings is limited. We assessed the impact of a decision analysis tool (DAT) for pregnant women on mode of birth (MOB) within the QUALIty DECision-making project, a multisite, multicountry pragmatic trial to reduce unnecessary ca…
Financial and regulatory interventions to reduce unnecessary caesarean sections
Caesarean section (CS) is a life-saving procedure and a critical component of comprehensive obstetric care, yet CS rates are rising globally beyond levels justified by clinical indications. Growing evidence suggests that health system supply-side factors, such as provider payment models that financially reward CS over vaginal birth and the absence or weak enforcement of clinical guidelines, are contributing to this trend. Despite increasing conce…
Rising caesarean section rates and factors affecting women’s decision-making about mode of birth in Indonesia
INTRODUCTION: Caesarean section (CS) rates in Indonesia are increasing rapidly. Understanding women's preferences about mode of birth is important to help contextualise these rising rates and can help develop interventions to optimise CS. This study aimed to explore Indonesian women's preferences and decision-making about mode of birth, and how their preferences may change throughout pregnancy and birth. METHODS: We conducted a longitudinal quali…
Engaging women to set the research agenda for assisted vaginal birth
INTRODUCTION: Public and patient involvement can provide crucial insights to optimise research by enhancing relevance and appropriateness of studies. The World Health Organization (WHO) engaged in an inclusive process to ensure that both technical experts and women had a voice in defining the research gaps and needs to increase or reintroduce the use of assisted vaginal birth (AVB) in settings where this intervention is needed but unavailable or …
Feasibility and readiness to implement Robson classification to monitor caesarean sections in public hospitals in Myanmar
Recent years have demonstrated an increase in caesarean section (CS) in most countries worldwide with considerable concern for the potential consequences. In 2015, WHO proposed the use of Robson classification as a global standard for assessing, monitoring and comparing CS rates. Currently, there is no standardized method to assess CS in Myanmar. The aim of this study was to explore health provider’s perceptions about the feasibility, acceptabili…
Implementing the Quali-DEC project in Argentina, Burkina Faso, Thailand and Viet Nam
The project ‘Quality Decision-making by women and providers’ (QUALI-DEC) combines four non-clinical interventions to promote informed decision-making surrounding mode of birth, improve women’s birth experiences, and reduce caesarean sections among low-risk women. QUALI-DEC is currently being implemented in 32 healthcare facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. In this paper, we detail implementation processes and the pla…
Educational interventions targeting pregnant women to optimise the use of caesarean section
We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the iden…
Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries
Women’s fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burk…
Trends and projections of caesarean section rates
BACKGROUND: The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. METHODS: We obtained nationally representative data on the CS rate from countries worldwide from 1990 to 2018. We used routine health information systems reports and population-based household surveys. Using the latest available da…
Lessons from a multidisciplinary partnership involving women parliamentarians to address the overuse of caesarean section in Italy
The increase of caesarean sections (CS) represents a global concern. Interventions tested to reduce unnecessary caesareans have shown limited success to date, partly because they have focused on medical perspectives or on single faceted interventions targeting only one group of stakeholders. Limited attention has been given to examining multidisciplinary and advocacy activities that could reduce unnecessary CS by raising awareness and engaging th…
Mass media campaigns to reduce unnecessary caesarean sections
Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017
INTRODUCTION: Caesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This stu…
Assessing scalability of an intervention
Public health interventions should be designed with scale in mind, and researchers and implementers must plan for scale-up at an early stage. Yet, there is limited awareness among researchers of the critical value of considering scalability and relatively limited empirical evidence on assessing scalability, despite emerging methodological guidance. We aimed to integrate scalability considerations in the design of a study to evaluate a multi-compo…
Preterm Birth in China Between 2015 and 2016
Objectives. To describe the incidence, risk factors, and potential causes of preterm birth (PTB) in China between 2015 and 2016. Methods. The China Labor and Delivery Survey was a population-based multicenter study conducted from 2015 to 2016. We assigned each birth a weight based on the sampling frame. We calculated the incidence of PTB and the multivariable logistic regression, and we used 2-step cluster analysis to examine the relationships be…
Early neonatal mortality in twin pregnancy
BACKGROUND: Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth at…
Caesarean delivery and anaemia risk in children in 45 low‐ and middle‐income countries
Caesarean delivery (CD) may reduce placental transfusion and cause poor iron-related haematological indices in the neonate. We aimed to explore the association between CD and anaemia in children aged 2 = 40.2%), mild anaemia (OR 0.91, 95% CI [0.81, 1.02]; I 2 = 24.8%), and moderate/severe anaemia (OR 0.97, 95% CI [0.85, 1.11]; I 2 = 47.7%). CD tended to be positively associated with moderate/severe anaemia in upper middle-income countries and neg…
WHO Statement on Caesarean Section Rates
In 1985 when a group of experts convened by the World Health Organization in Fortaleza, Brazil, met to discuss the appropriate technology for birth, they echoed what at that moment was considered an unjustified and remarkable increase of caesarean section (CS) rates worldwide.1 Based on the evidence available at that time, the experts in Fortaleza concluded: ‘there is no justification for any region to have a caesarean section rate higher than 10…
The Increasing Trend in Caesarean Section Rates
BACKGROUND: Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years. METHODS: We collected nationally-representative data on CS rates between 1990 to 2014 and calculated regional and subregional weighted averages. We conducted a …
Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia
We found inequity in utilization of EmOC in favour of the wealthiest. Assessing and monitoring equitable utilization of maternity services is feasible using this simple tool
The role of faith‐based organizations in maternal and newborn health care in Africa
BACKGROUND: Global disparities in maternal and newborn health represent one of the starkest health inequities of our times. Faith-based organizations (FBOs) have historically played an important role in providing maternal/newborn health services in African countries. However, the contribution of FBOs in service delivery is insufficiently recognized and mapped. OBJECTIVES: A systematic review of the literature to assess available evidence on the r…
Tackling Health Inequities in Chile
Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neo…
The Introduction of Confidential Enquiries into Maternal Deaths and Near-Miss Case Reviews in the WHO European Region
Most maternal deaths can be averted with known, effective interventions but countries require information about which women are dying and why, and what can been done to prevent such deaths in future. This paper describes the introduction of two approaches to reviewing maternal deaths and severe obstetric complications in 12 countries in transition in the WHO European Region – national-level confidential enquiries into maternal deaths and facility…
Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world
Objective We estimate attributable fractions, deaths and years of life lost among infants and children ≤2 years of age due to suboptimal breast-feeding in developing countries. Design We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants ≤6 months of age and continued breast-feeding for older infants and children ≤2 years of age. For infants, we consider deaths due to diarrhoeal disease and l…
Assessing scalability of an intervention
Public health interventions should be designed with scale in mind, and researchers and implementers must plan for scale-up at an early stage. Yet, there is limited awareness among researchers of the critical value of considering scalability and relatively limited empirical evidence on assessing scalability, despite emerging methodological guidance. We aimed to integrate scalability considerations in the design of a study to evaluate a multi-compo…
Tackling Health Inequities in Chile
Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neo…
Deaths and years of life lost due to suboptimal breast-feeding among children in the developing world
Objective We estimate attributable fractions, deaths and years of life lost among infants and children ≤2 years of age due to suboptimal breast-feeding in developing countries. Design We compare actual practices to a minimum exposure pattern consisting of exclusive breast-feeding for infants ≤6 months of age and continued breast-feeding for older infants and children ≤2 years of age. For infants, we consider deaths due to diarrhoeal disease and l…
The Introduction of Confidential Enquiries into Maternal Deaths and Near-Miss Case Reviews in the WHO European Region
Most maternal deaths can be averted with known, effective interventions but countries require information about which women are dying and why, and what can been done to prevent such deaths in future. This paper describes the introduction of two approaches to reviewing maternal deaths and severe obstetric complications in 12 countries in transition in the WHO European Region – national-level confidential enquiries into maternal deaths and facility…
Tackling Health Inequities in Chile
Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4 000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neo…
The role of faith‐based organizations in maternal and newborn health care in Africa
BACKGROUND: Global disparities in maternal and newborn health represent one of the starkest health inequities of our times. Faith-based organizations (FBOs) have historically played an important role in providing maternal/newborn health services in African countries. However, the contribution of FBOs in service delivery is insufficiently recognized and mapped. OBJECTIVES: A systematic review of the literature to assess available evidence on the r…
Measuring equity in utilization of emergency obstetric care at Wolisso Hospital in Oromiya, Ethiopia
We found inequity in utilization of EmOC in favour of the wealthiest. Assessing and monitoring equitable utilization of maternity services is feasible using this simple tool
WHO Statement on Caesarean Section Rates
In 1985 when a group of experts convened by the World Health Organization in Fortaleza, Brazil, met to discuss the appropriate technology for birth, they echoed what at that moment was considered an unjustified and remarkable increase of caesarean section (CS) rates worldwide.1 Based on the evidence available at that time, the experts in Fortaleza concluded: ‘there is no justification for any region to have a caesarean section rate higher than 10…
The Increasing Trend in Caesarean Section Rates
BACKGROUND: Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years. METHODS: We collected nationally-representative data on CS rates between 1990 to 2014 and calculated regional and subregional weighted averages. We conducted a …
Caesarean delivery and anaemia risk in children in 45 low‐ and middle‐income countries
Caesarean delivery (CD) may reduce placental transfusion and cause poor iron-related haematological indices in the neonate. We aimed to explore the association between CD and anaemia in children aged 2 = 40.2%), mild anaemia (OR 0.91, 95% CI [0.81, 1.02]; I 2 = 24.8%), and moderate/severe anaemia (OR 0.97, 95% CI [0.85, 1.11]; I 2 = 47.7%). CD tended to be positively associated with moderate/severe anaemia in upper middle-income countries and neg…
Early neonatal mortality in twin pregnancy
BACKGROUND: Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth at…
Assessing scalability of an intervention
Public health interventions should be designed with scale in mind, and researchers and implementers must plan for scale-up at an early stage. Yet, there is limited awareness among researchers of the critical value of considering scalability and relatively limited empirical evidence on assessing scalability, despite emerging methodological guidance. We aimed to integrate scalability considerations in the design of a study to evaluate a multi-compo…
Preterm Birth in China Between 2015 and 2016
Objectives. To describe the incidence, risk factors, and potential causes of preterm birth (PTB) in China between 2015 and 2016. Methods. The China Labor and Delivery Survey was a population-based multicenter study conducted from 2015 to 2016. We assigned each birth a weight based on the sampling frame. We calculated the incidence of PTB and the multivariable logistic regression, and we used 2-step cluster analysis to examine the relationships be…
Lessons from a multidisciplinary partnership involving women parliamentarians to address the overuse of caesarean section in Italy
The increase of caesarean sections (CS) represents a global concern. Interventions tested to reduce unnecessary caesareans have shown limited success to date, partly because they have focused on medical perspectives or on single faceted interventions targeting only one group of stakeholders. Limited attention has been given to examining multidisciplinary and advocacy activities that could reduce unnecessary CS by raising awareness and engaging th…
Mass media campaigns to reduce unnecessary caesarean sections
Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017
INTRODUCTION: Caesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This stu…
Trends and projections of caesarean section rates
BACKGROUND: The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. METHODS: We obtained nationally representative data on the CS rate from countries worldwide from 1990 to 2018. We used routine health information systems reports and population-based household surveys. Using the latest available da…
Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries
Women’s fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burk…
Feasibility and readiness to implement Robson classification to monitor caesarean sections in public hospitals in Myanmar
Recent years have demonstrated an increase in caesarean section (CS) in most countries worldwide with considerable concern for the potential consequences. In 2015, WHO proposed the use of Robson classification as a global standard for assessing, monitoring and comparing CS rates. Currently, there is no standardized method to assess CS in Myanmar. The aim of this study was to explore health provider’s perceptions about the feasibility, acceptabili…
Implementing the Quali-DEC project in Argentina, Burkina Faso, Thailand and Viet Nam
The project ‘Quality Decision-making by women and providers’ (QUALI-DEC) combines four non-clinical interventions to promote informed decision-making surrounding mode of birth, improve women’s birth experiences, and reduce caesarean sections among low-risk women. QUALI-DEC is currently being implemented in 32 healthcare facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. In this paper, we detail implementation processes and the pla…
Educational interventions targeting pregnant women to optimise the use of caesarean section
We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the iden…
Rising caesarean section rates and factors affecting women’s decision-making about mode of birth in Indonesia
INTRODUCTION: Caesarean section (CS) rates in Indonesia are increasing rapidly. Understanding women's preferences about mode of birth is important to help contextualise these rising rates and can help develop interventions to optimise CS. This study aimed to explore Indonesian women's preferences and decision-making about mode of birth, and how their preferences may change throughout pregnancy and birth. METHODS: We conducted a longitudinal quali…
Engaging women to set the research agenda for assisted vaginal birth
INTRODUCTION: Public and patient involvement can provide crucial insights to optimise research by enhancing relevance and appropriateness of studies. The World Health Organization (WHO) engaged in an inclusive process to ensure that both technical experts and women had a voice in defining the research gaps and needs to increase or reintroduce the use of assisted vaginal birth (AVB) in settings where this intervention is needed but unavailable or …
Implementation of a decision aid to promote shared decision-making on mode of birth in low-risk pregnant women
INTRODUCTION: Implementing shared decision-making (SDM) in maternity care remains challenging in low-income and middle-income countries (LMICs). Decision aids can support SDM, but evidence on their effectiveness in such settings is limited. We assessed the impact of a decision analysis tool (DAT) for pregnant women on mode of birth (MOB) within the QUALIty DECision-making project, a multisite, multicountry pragmatic trial to reduce unnecessary ca…
Financial and regulatory interventions to reduce unnecessary caesarean sections
Caesarean section (CS) is a life-saving procedure and a critical component of comprehensive obstetric care, yet CS rates are rising globally beyond levels justified by clinical indications. Growing evidence suggests that health system supply-side factors, such as provider payment models that financially reward CS over vaginal birth and the absence or weak enforcement of clinical guidelines, are contributing to this trend. Despite increasing conce…
Medicine (17 obras) · Global Maternal and Child Health (15 obras) · Pregnancy (14 obras) · Maternal and Perinatal Health Interventions (13 obras) · Caesarean section (10 obras) · Demography (9 obras) · Nursing (9 obras) · Political science (8 obras) · Geography (7 obras) · Computer Science (6 obras)