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1.  Cesarean section deliveries in the occupied Palestinian territory (oPt): An analysis of the 2006 Palestinian Family Health Survey 
Objective
Against the backdrop of a rise in cesarean section deliveries from 6.0% in 1996 to 14.8% in 2006, the objective of this study was to investigate socio-demographic, clinical and service-related factors associated with cesarean sections in the occupied Palestinian territory.
Methods
Data from the Palestinian Family Health Survey 2006 were used to examine last births in the 5 years preceding the survey to women aged 15–49 years. Bivariate and multivariate associations between type of delivery (dependent variable) and selected factors were analyzed using logistic regression. Selected maternal outcomes were also investigated with type of delivery as the independent variable.
Results
Cesarean section deliveries were significantly associated with maternal age (35+ years), primiparity, low birth weight and residence area in the West Bank and Gaza. There was no significant difference in the prevalence of cesarean deliveries by sector in the West Bank, but in Gaza, they were significantly more common in the governmental sector.
Conclusions
There is a need for detailed audits of cesarean section deliveries, nationally and at the facility level, in order to avoid unnecessary interventions in the context of high fertility, rising poverty and fragmented health services. Variations by governorate should be studied further for focused interventions.
doi:10.1016/j.healthpol.2009.07.006
PMCID: PMC2789246  PMID: 19674810
Cesarean sections; Prevalence; Developing countries; Health systems
2.  The limitations on choice: Palestinian women's childbirth location, dissatisfaction with the place of birth and determinants 
Background:
Analysing the Palestinian Central Bureau of Statistics (PCBS) Demographic and Health Survey 2004 (DHS-2004) data, this article focuses on the question of where women living in the Occupied Palestinian Territory give birth, and whether it was the preferred/place of choice for delivery. We further identify some of the determinants of women's dissatisfaction with childbirth location.
Methods:
A total of 2158 women residing in the West Bank and Gaza Strip were included in this study. Regression analysis established the association between dissatisfaction with the place of birth and selected determinants.
Results:
A total of 3.5% of women delivered at home, with the rest in assisted facilities. Overall, 20.5% of women reported that their childbirth location was not the preferred place of delivery. Women who delivered at home; in governmental facilities; in regions other than the central West Bank; who had sudden delivery or did not reach their preferred childbirth location because of closures and siege; because of costs/the availability of insurance; or because there were no other locations available, were significantly more likely to be dissatisfied with their childbirth location compared to those who birthed in private facilities, the central West Bank, and in locations with better and more available services.
Conclusion:
The findings demonstrate that Palestinian women's choice of a place of birth is constrained and modified by the availability, affordability, and limited access to services induced by continuing closures and siege. These findings need to be taken into consideration when planning for maternity services in the Occupied Palestinian Territory.
doi:10.1093/eurpub/ckl089
PMCID: PMC1913630  PMID: 16798783
3.  Health sector reform in the Occupied Palestinian Territories (OPT): targeting the forest or the trees? 
Health policy and planning  2003;18(1):59-67.
Since the signing of the Oslo Peace Accords and the establishment of the Palestinian Authority in 1994, reform activities have targeted various spheres, including the health sector. Several international aid and UN organizations have been involved, as well as local and international non-governmental organizations, with considerable financial and technical investments. Although important achievements have been made, it is not evident that the quality of care has improved or that the most pressing health needs have been addressed, even before the second Palestinian Uprising that began in September 2000. The crisis of the Israeli re-invasion of Palestinian-controlled towns and villages since April 2002 and the attendant collapse of state structures and services have raised the problems to critical levels. This paper attempts to analyze some of the obstacles that have faced reform efforts. In our assessment, those include: ongoing conflict, frail Palestinian quasi-state structures and institutions, multiple and at times inappropriate donor policies and practices in the health sector, and a policy vacuum characterized by the absence of internal Palestinian debate on the type and direction of reform the country needs to take. In the face of all these considerations, it is important that reform efforts be flexible and consider realistically the political and economic contexts of the health system, rather than focus on mere narrow technical, managerial and financial solutions imported from the outside.
PMCID: PMC1457109  PMID: 12582108
health sector reform; conflict; Occupied Palestinian Territories

Results 1-3 (3)