# 1 INRO:EJCrION

This literature review gathers information on Jamaican health services, social problems, and maternal health. The review begins with scme background on Jamaica and goes on to the epidemiology of<sup>the major,</sup> pregnaicy-related, health problems affecting women. The review then broadens to see how childhood and other health experiences prior to conception may act as factors placing women at risk during pregnancy. Thie available health services, including family planning and prenatal care, are described along with current levels of utilization. Gaps in services will be identified as will potential barriers to access for particular sub-groups. The review ends with a discussion of issues that could be explored in upcoming studies in Jamaical.

2 BACKGROUND STATISTICS ON _JAM@ICA_ In ;985, the population of Jamaica was 2.2 million with a cnide birth rate of 24/1,000 and a fertility rate of 3.5 births per 1,000 wcmn of reproductive age (Folta, 1988; Jamaica-MOH, 1989). Life expectancy at birth is 70 years (World Bank, 1987). If there is no reduction in fertility and no major changes in rates of emigration, there will be a population of 3.5 million by the year 2000 (World Bank, 1987). Currently, it is estimated that between 40 to 58% of the population lives in rural areas and that in these areas, problems of poor ccmmunication, bad roads, and difficult access persist (Mitchell, 1983; Dressekie, 1988). The population is roughly 90% of West African descent, 6% Afro-European, and 4% is made up of East Indian, Afro-East Indian, Chinese, Afro-Chinese, and European (Mitchell, 1983). The original island inhabitants, the Arawak Indians, had been killed off by the time Britain took over the island from Spain in 1655. Jamaica is characterized by relatively high levels of both fertility and female labor force participation; furthermore, 32% of the households in Jamaica are headed by women. This means women are simultaneously mothers and market workers, and are very often the primary wage-earner (Powell et al., 1988). The multiple responsibilities of women may be the cause ox another social practice quite common in Jamaica- "passing on"--giving children up to another care-taker. In a sample of 131 women with living children, 57% passed on a total of 121 children (Brody, 1981); 58% of the children went to maternal grandmothers. Roberts & Sinclair (1978) found that of the women who gave their children away, 60% reported economic reasons for doing so; 50% reported the need to work. When one considers health service utilization it will be important to remember the multiple responsibilities of women and consider the limited resources they may have (time and money) to use to get medical attention. Recognizing the economic importance of women also adds 1 This literature review is ccuplete up until July 1989. At that time, the Ministry of Health in Jamaica was cumpleting the final report of its Perinatal Mortality and Morbidity Study which contains pertinent information on the state of prenatal care, performance of birth attendants, and maternal and infant health status. Some reference is made in this review to findings from this study; the reader is urged to go directly to the full report for more information.

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