A Review of Studies of the Effectiveness of Programs To Improve Pregnancy Outcome

Abstract

This article presents a critical review of the available evidence on the effectiveness of programs to improve pregnancy outcome in changing rates of infant mortality. A total of 27 secondary reviews and original evaluation articles were assessed for quality of evidence on program outcomes. Although infant mortality rates are clearly dropping, initial review of the studies showed that history, differential selection, and experimental mortality were powerful alternative hypotheses to the conclusion that any particular program can claim to have caused the drop. Thus, our knowledge of exactly which programs are effective, and which are not, is compromised.