weight to the tragedy of maternal death; if the woman was a major contributor to the household income, or indeed if she was the sole provider, who will care for the surviving children of the deceased mother? Another special characteristic in Jamaican society is the low prevalence of legal marriage. Stycos and Back (1964) first described the four categories of union which are now referred to by all researchers: married, ccmmon law, visiting relationships, and single. Marriage is normally entered into later in life and is associated with considerable improvements in a woman s social status (Bracken & Kasl, 1973). Ccmmon law relationships are stable cohabiting unions considered by some to be the equivalent of marriage. Blake (1961) found that few of these lead to marriage among the lower class Jamaicans; others have suggested this may vary in urban and rural areas and in fact, ccommn law relationships could lead to marriage. Visiting relationships are non-cohabiting sexual relationships which persist for variously defined periods of time. Brody (1981) found that the unions which lasted longest were associated with more consistent contraceptive use and greater partner communication. Women in a visiting relationship, who had high numbers of partners and children in the past, were more likely to pass on children born in the current relationship (Brody, 1981). The union status of wcoen from the Perinatal Study broke down as 43.8% in a visiting union, 36.4% ocnmn law, 14.6% married, and 5.2% not with husband or boyfriend, or other (Jamaica-MOH, 1989). The prevalence of unstable unions has been blamed for high fertility in Jamaica. Blake (1961) found that women were aware of the financial demands of large families and wanted smaller ones but chose to have children for the partner in their present union so he would not "became bored". Additionally, children from a terminated union remain with the mother; men who desire parenthood must get children in their present unions (Brody, 1981). Unstable families are created and disbanded then as sexual unions are formed and broken. Brody claimed, on the basis of an analysis of sex, contraception, and childbearing, that "coitus and parenthood seem more important for the man and woman as individuals rather than as members of a partnership". Brody also believed that young wcmen entered into childbearing to break from their parents and to establish themselves as wcmen; the first union was unimportant except as a vehicle to get the pregnancy.

# 3 MATERNAL HEALITH PROBLEMS AND NEEDS

One problem in studying maternal health is getting accurate counts of morbidity and mortality and measuring the incidence and severity of chronic disability. Countries use varying definitions of what constitutes a maternal death; the International Classification of Diseases (ICD)-9 definition says, "A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of pregnancy, fram any cause related to or aggravated by the pregnancy or its managenent but not fram accidental or incidental causes. **'** ICD-9 further divides i,aternal deaths into direct and indirect causes-indirect being due to preexisting conditions aggravated by the pregnancy. Marty countries fail to distinguish deaths by timing relative to pregnancy termination or according to direct or indirect causes. Countries also differ in thie reported numbers of deaths due to the various maternal causes. Sitge sources of these deviations are that countries may not record the cause of death (some report up to 60% of female d-aths due 2