Orientation on
Quality Maternal Health Care
Service Package

Dr Theingi Myint
Deputy Director (MCH)
Department of Health
1...
Pregnancy and Childbirth
Global Situation
Becoming a mother can be dangerous
and life-threatening.
More than 350,000 women...
Pregnancy and Childbirth
Myanmar Situation (Estimation)
1 million pregnancies every year
325,000 unwanted pregnancies
2...
MDG Goal 5: Improve maternal health
Target
Improve maternal health

Indicators
Maternal mortality ratio
Proportion of birt...
MDG 5 related RH Indicator
N
o

Indicators

1.

Maternal mortality ratio
(/100,000 LB)
Source: UN I
Estimation

2.

1990

...
nm
ar
M
ya

Source: UN-Inter Agency Estimates, 2012

6|
Source: UN-Inter Agency Estimates, 2012

7|
Maternal Mortality Ratio in Myanmar

8|

Source: UN
MMR (per 1000 LBs)

9|
Causes of maternal mortality (Global)

Hypertensive
disorders
12%
Other direct
causes
8%

Indirect
causes
20%
10 |

Unsafe...
Causes of Maternal Mortality in Myanmar

Source| : Nationwide Cause Specific Maternal Mortality Survey 2004-2005,
11

DOH/...
Progress is possible and it is happening
% increase in the SBA coverage
% increase in the institutional delivery

41

39.4...
Institutional Delivery

13 |
Institutional Delivery & Skill Birth
Attendance

14 |
Abortion Rate (%)

15 |
MCH Vs Reproductive Health

16 |
MCH Versus Reproductive Health
Main activities of MCH Essential RH care
Antenatal care
Safe and aseptic delivery
Postnat...
Essential RH care

Safe Motherhood
Post – Abortion Care
Birth Spacing
RTI/ STI including HIV/AIDS
Adolescent Reproductive
...
Essential RH care

Safe Motherhood

19 |
Our Goal for Safe Motherhood

Reduction of maternal and newborn mortality
and morbidity
- the silent tragedies
20 |
But WHY Do These Women Die?
( Three delays Model)
 Delay in decision to seek care
–
–
–
–

Lack of understanding of compl...
Recognition

22 |
Recognition

23 |

Referral
Recognition

24 |

Referral

Responsiveness
The Six Pillars of Safe Motherhood

STD-HIV Control

Post-Abortion Care

Post-Natal Care

Obstetric Care

Ante-Natal Care
...
Essential RH care

Post – Abortion Care

26 |
Elements of Post abortion Care

Emergency
Treatment

BS Counseling
& Services
Other
Reproductive
Health Services

27 |
Essential RH care

Birth Spacing

28 |
Family Planning Vs Birth Spacing
Population Ground

Health Ground

Permanent Method and
Temporary Method

Temporary Me...
Essential RH care

RTI/ STI including HIV/AIDS

30 |
Different types of RTIs

RTI
EXOGENOUS

ENDOGENOUS

IATROGENIC

Through Sexual Activity
Eg. Syphillis
AIDS

Overgrowth of ...
Essential RH care

Adolescent Reproductive Health

32 |
33 |
Saving mothers and newborn lives
No more about technology but it

is about quality, access and
coverage

34 |
We know what needs to be done:
Technology is available for very long time
Skilled care during pregnancy, childbirth and
p...
We know what didn’t work
 Traditional

Birth Attendants as skilled birth

attendants
 Risk

approach

 Focusing

36 |

...
The new paradigm in reducing
Maternal Mortality and Peri-natal Mortality
All pregnancies are at risk: Most
obstetrical co...
What we need
Skilled Birth Attendants for 100% of
deliveries
Emergency obstetric care for the 15% of
deliveries where it...
Why Skilled Care at Every Birth?
Most complications and deaths occur
during childbirth and immediately after birth
Right...
Reason for not going to health facility
( countries in South, South East Asia (N= 82022 women 5

100

80

60

%

46.5
42.0...
41 |
Maternal deaths per 1000000 live births

The higher the proportion of deliveries attended by skilled
attendant in a countr...
Child Deaths per 1,000 Live Births

What Happens to the Children
When a Parent Dies?

No Parent Dies

43 |

Father Dies

M...
FOCUSED ANTENATAL CARE
FIRST VISIT (as soon as ,
within 3 month)











Take history
Perform physical examin...
AN Care Vinyl

45 |
ta=ccHta7;ay:
om;zGm;=yKpkapmifha&Smuf=cif;
Basic Emergency Obstetric Care

(1) yÃdZD0aq;udk xdk;ay;=cif;
Administer paren...
=yD;=ynfhpHkaomta7;ay:
om;zGm;=yKpkapmifha&Smuf=cif;
Comprehensive Emergency Obstetric Care

aq;&HkwGifuko7ef
ta=ccHta7;ay...
Basic Emergency Care
Ante Partum and Post Partum Hemorrhage
Prolonged labour and Uterine rupture
Severe Pre Eclampsia a...
49 |
THANK YOU

50 |
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Quality maternal health care services

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  • Our perception is that women do not avail services because of lack of knowledge or permission, however, this analysis showed that that majority of women do not seek general care mainly because of lack of money, distance, and transport which is ultimately related to cost and financial ability.
  • Attended birth instead of unattended.
  • Transcript of "Quality maternal health care services"

    1. 1. Orientation on Quality Maternal Health Care Service Package Dr Theingi Myint Deputy Director (MCH) Department of Health 1|
    2. 2. Pregnancy and Childbirth Global Situation Becoming a mother can be dangerous and life-threatening. More than 350,000 women die annually in pregnancy and childbirth, most from preventable causes: Every day 1,000 women die giving life, One every 90 seconds. This year an estimated 5.8 million newborns will die before their first birthday. The risk is greatest for women in poor countries and for poor women in all 2|
    3. 3. Pregnancy and Childbirth Myanmar Situation (Estimation) 1 million pregnancies every year 325,000 unwanted pregnancies 246,000 unsafe abortions  2,000 women die from complications (Average – 7 death in one township) 24,600 newborns die within the first week of life 15,000 babies are born dead 3|
    4. 4. MDG Goal 5: Improve maternal health Target Improve maternal health Indicators Maternal mortality ratio Proportion of births attended by skilled health personnel Achieve, by 2015, universal access to reproductive health Contraceptive prevalence rate Adolescent birth rate Antenatal care coverage (at least one visit and at least four visits) Unmet need for family planning 4|
    5. 5. MDG 5 related RH Indicator N o Indicators 1. Maternal mortality ratio (/100,000 LB) Source: UN I Estimation 2. 1990 1995 2000 520 380 2001 300 Proportion of births attended by skilled health personnel (%) Source: HMIS MICS IHLCA 2005 2006 57.9 2010 2011 63.5 64.1 67. 0 2015 130 64.4 64.8 67.1 80 70.6 77.9 4. Adolescent birth rate (%) Source: FRHS 17.4 5. Antenatal care coverage (%) Source: HMIS MICS IHLCA Unmet need for family planning (%) 5| Source: FRHS 2009 200 37 6. 200 8 230 Contraceptive Prevalence rate (%) Source: FRHS MICS IHLCA 3. 2007 41 (all) 38 50 46 (modern) 39.5 16.9 63.1 63.9 64.6 15 68. 2 70.6 73 74.3 80 83.1 83.3 19.1 17.7 10
    6. 6. nm ar M ya Source: UN-Inter Agency Estimates, 2012 6|
    7. 7. Source: UN-Inter Agency Estimates, 2012 7|
    8. 8. Maternal Mortality Ratio in Myanmar 8| Source: UN
    9. 9. MMR (per 1000 LBs) 9|
    10. 10. Causes of maternal mortality (Global) Hypertensive disorders 12% Other direct causes 8% Indirect causes 20% 10 | Unsafe abortion 13% Sepsis 15% Obstructed labour 8% Haemorrhage 24%
    11. 11. Causes of Maternal Mortality in Myanmar Source| : Nationwide Cause Specific Maternal Mortality Survey 2004-2005, 11 DOH/UNICEF
    12. 12. Progress is possible and it is happening % increase in the SBA coverage % increase in the institutional delivery 41 39.4 36.7 30 SBA and institutional coverage over 90% 27.1 25.2 25.2 18.5 15 9.6 7 5.1 9.9 10.1 13.1 14 12.8 10.6 7 2.7 2.3 1.6 Armenia (2001-2005) 12 | Dominican Republic (1991-2007) Phillippines (1993-2003) Nepal (2001- Senegal (1986Namibia Ghana (19882006) 2005) (1992-2006/7) 2008) Nicaragua Rwanda (1992- Indonesia (1998-2001) 2007) (1987-2007) Egypt (19952005)
    13. 13. Institutional Delivery 13 |
    14. 14. Institutional Delivery & Skill Birth Attendance 14 |
    15. 15. Abortion Rate (%) 15 |
    16. 16. MCH Vs Reproductive Health 16 |
    17. 17. MCH Versus Reproductive Health Main activities of MCH Essential RH care Antenatal care Safe and aseptic delivery Postnatal care Neonatal care Under 5 care Nutritional development for mothers and children Immunization MCH care including Antenatal care, Safe and aseptic delivery, Postnatal care, Neonatal care ( Safe Motherhood) Post – Abortion Care Birth Spacing RTI/ STI including HIV/AIDS Adolescent Reproductive Health Comprehensive RH care Infertility Violence against Women Osteoporosis, Ca Cervix etc 17 |
    18. 18. Essential RH care Safe Motherhood Post – Abortion Care Birth Spacing RTI/ STI including HIV/AIDS Adolescent Reproductive Health and Male Involvement 18 |
    19. 19. Essential RH care Safe Motherhood 19 |
    20. 20. Our Goal for Safe Motherhood Reduction of maternal and newborn mortality and morbidity - the silent tragedies 20 |
    21. 21. But WHY Do These Women Die? ( Three delays Model)  Delay in decision to seek care – – – – Lack of understanding of complications Acceptance of maternal death Low status of women Socio-cultural barriers to seeking care  Delay in reaching care – Mountains, islands, rivers — poor organization  Delay in receiving care – Supplies, personnel – Poorly trained personnel with punitive attitude – Finances 21 |
    22. 22. Recognition 22 |
    23. 23. Recognition 23 | Referral
    24. 24. Recognition 24 | Referral Responsiveness
    25. 25. The Six Pillars of Safe Motherhood STD-HIV Control Post-Abortion Care Post-Natal Care Obstetric Care Ante-Natal Care Birth Spacing Safe Motherhood Communication for Behavior Change Primary Health Care Equity and Education for Women 25 |
    26. 26. Essential RH care Post – Abortion Care 26 |
    27. 27. Elements of Post abortion Care Emergency Treatment BS Counseling & Services Other Reproductive Health Services 27 |
    28. 28. Essential RH care Birth Spacing 28 |
    29. 29. Family Planning Vs Birth Spacing Population Ground Health Ground Permanent Method and Temporary Method Temporary Method Eg. Sterilization 29 | Eg. Contraceptive Pills
    30. 30. Essential RH care RTI/ STI including HIV/AIDS 30 |
    31. 31. Different types of RTIs RTI EXOGENOUS ENDOGENOUS IATROGENIC Through Sexual Activity Eg. Syphillis AIDS Overgrowth of Normal Flora Eg. Bacterial Vaginosis Candidiasis Through Medical Procedure Eg. IUD Insertion 31 |
    32. 32. Essential RH care Adolescent Reproductive Health 32 |
    33. 33. 33 |
    34. 34. Saving mothers and newborn lives No more about technology but it is about quality, access and coverage 34 |
    35. 35. We know what needs to be done: Technology is available for very long time Skilled care during pregnancy, childbirth and post partum/post natal period Access to emergency obstetric and newborn care Access to family planning/ Birth Spacing 35 |
    36. 36. We know what didn’t work  Traditional Birth Attendants as skilled birth attendants  Risk approach  Focusing 36 | efforts on antenatal care alone
    37. 37. The new paradigm in reducing Maternal Mortality and Peri-natal Mortality All pregnancies are at risk: Most obstetrical complications are neither predictable, nor avoidable, but can be treated Shift of focus from pregnancy to delivery, and from home to facility Therefore, readiness is key, accompanied by quality of obstetric care 37 |
    38. 38. What we need Skilled Birth Attendants for 100% of deliveries Emergency obstetric care for the 15% of deliveries where it is needed (at least 7% mothers and 9-15% newborns) Basic Emergency Obstetric Care (6) Comprehensive Emergency Obstetric Care Referral from community to facilities 38 |
    39. 39. Why Skilled Care at Every Birth? Most complications and deaths occur during childbirth and immediately after birth Rights of all women and newborns – government’s responsibility Many countries have a low proportion of births attended by skilled attendants Commitment towards achieving MDGs 5 and 4 39 |
    40. 40. Reason for not going to health facility ( countries in South, South East Asia (N= 82022 women 5 100 80 60 % 46.5 42.0 40 $33.4 30.1 23.4 29.9 23.2 31.9 26.8 26.2 22.1 $17.1 20 5.4 5.6 $5.1 9.5 11.2 $10.7 $6.4 $10.5 $14.3 0 Knowing where to go for treatment Getting permission to go for treatment Getting money for treatment Total 40 | Distance to health facility Rural Having to take transport Urban Not wanting to go alone Concern there may not be a female provider
    41. 41. 41 |
    42. 42. Maternal deaths per 1000000 live births The higher the proportion of deliveries attended by skilled attendant in a country, the lower the country’s maternal mortality ratio % skilled attendant at delivery 42 |
    43. 43. Child Deaths per 1,000 Live Births What Happens to the Children When a Parent Dies? No Parent Dies 43 | Father Dies Mother Dies
    44. 44. FOCUSED ANTENATAL CARE FIRST VISIT (as soon as , within 3 month)           Take history Perform physical examination, including vaginal exam Look for clinical signs of anaemia Test urine for bacteriuria, protein Screen for syphilis Give tetanus toxoid, iron folate Advise on individual birth plan, healthy lifestyle Tell her about danger signs Refer if necessary Complete clinic & home based records      Perform physical examination. Check for twins Listen to foetal heart sounds Test urine for bacteriuria, protein Check haemoglobin Give iron folate Give tetanus toxoid (if 4 weeks from first dose) Review individual birth plan, advise on healthy lifestyle Refer if necessary  THIRD VISIT (8 month)        SECOND VISIT (6-7 months)   44 |   Perform physical examination Listen for foetal heart sounds Test urine for bacteriuria, protein Give iron folate and mebendazole Review individual birth plan, advise on healthy lifestyle Refer if necessary Complete clinic & home based records FOURTH VISIT ( 9 month)        Perform physical examination. Check fetal lie and presentation Listen to foetal heart sounds Test urine for bacteriuria, protein Give iron folate Tell her about signs of labour Review individual birth plan, what to do if not delivered by end of week 41 Refer if necessary
    45. 45. AN Care Vinyl 45 |
    46. 46. ta=ccHta7;ay: om;zGm;=yKpkapmifha&Smuf=cif; Basic Emergency Obstetric Care (1) yÃdZD0aq;udk xdk;ay;=cif; Administer parenteral antibiotics (2) om;tdrfusHKhaq;xdk;ay;=cif; Administer parenteral oxytocic drugs (3) udk,f0efqdyfwuf a7m*gajumifh wufaeaom vlemtm; twufusaq;xdk;ay;=cif; Administer parenteral anticonvulsants for eclmpsia (4) tcsif;rusaom vlemtm; vufESifhcGmxkwfay;=cif; Perform manual removal of placenta (5) uav;ysufaom vlemwGif usefaeaom tcsif;ESifh oaE<om; tptersm;tm; z,fxkwfay;=cif; Perform manual removal of retained products (6) uav;tarG; jumaeaom vlemtm; ulI nSyfqGJarG;ay;=cif;/ 46 |
    47. 47. =yD;=ynfhpHkaomta7;ay: om;zGm;=yKpkapmifha&Smuf=cif; Comprehensive Emergency Obstetric Care aq;&HkwGifuko7ef ta=ccHta7;ay: om;zGm;=yKpkapmifha&Smuf=cif; vkyfief; (6) 7yf (7) cGJpdwfukoay;=cif; Perform surgery (8) aoG;oGif;ukoay;=cif; Perform blood transfusion (9) arhaq;ay;=cif; Perform anaesthesia 47 |
    48. 48. Basic Emergency Care Ante Partum and Post Partum Hemorrhage Prolonged labour and Uterine rupture Severe Pre Eclampsia and Eclampsia Puerperial Sepsis Abortion related Complications 48 |
    49. 49. 49 |
    50. 50. THANK YOU 50 |
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