Maternal Mortality - Global IssuePresentation Transcript
Improving Maternal Mortality: Policy Perspectives Presented by: Rachel Koffman Crystal Lawrence Tseli Mohammed International health Policy Heller School for social policy Brandeis university
Warm Up: What Do You Know About Maternal Mortality?
Background, Root Causes and Measurement
Case Study: Highest Maternal Mortality
Case Study: Lowest Maternal Mortality
Moving Forward: Recommendations
Which country below has the highest maternal mortality ratio (MMR)?
Which country below has the lowest maternal mortality ratio (MMR)?
Every day 1,500 women die due to pregnancy and/or childbirth.
Annually more than 500,000 women die due to complications during pregnancy or childbirth, 99% of these are in developing countries.
Women in poor nations are 300 times more likely to die. Of these, more than half are in Africa.
In sub-Saharan Africa, a woman’s maternal mortality risk is 1 in 30, compared to 1 in 5,600 in developed regions.
Rural and poor women who do not have equal access to quality skilled care are the most affected. The gap in accessing skilled care is widest between urban and rural areas, and between rich and poor women.
Additionally, HIV/AIDS, malaria, and anemia before and during pregnancy increase pregnant women’s risk of dying.
control of their fertility and reproductive rights
Socio-cultural practices and traditions
Poor healthcare and systems for women
Lack of sanitation and hygienic practices (water)
Lack of policies and standards for maintaining women’s rights, protection and empowerment
Maternal Mortality Ratio : the annual number of deaths of women from pregnancy-related causes per 100,000 live births.
Indicator used most often to describe the level of maternal health and maternal mortality.
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 site of the pregnancy, from any cause related to, or aggravated by the pregnancy or its management but not from accidental or incidental causes.
MDGs # 5: Improve Maternal Health :
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.
Achieve, by 2015, universal access to reproductive health.
Also MDG #6 Combat AIDS, malaria, and other diseases and MDG #3 Promote Gender Equality and Empower Women are critical to improving maternal health
WHO: Making Pregnancy Safer
Care during pregnancy
Care during and after delivery
Post partum family planning
Maternal Mortality in Sierra Leone
MMR in Sierra Leone:
Only 42% of deliveries are attended by a skilled attendant
Less than 1/5 deliveries are carried out in health facilities
1/5 of women receive no antenatal care
The fertility rate is estimated at 5.1-6.1 children per woman
6 of 13 districts have no emergency obstetric care at all, depriving women in these districts of access to life-saving caesarean sections and blood transfusions
Maternal Mortality in Sierra Leone
Unavailability and inequitable distribution of health services, including skilled health personnel and emergency obstetric services
Insufficient drugs, medical equipment and supplies
Poorly equipped and inadequate referral system
Lack of adequate training and supervision of medical personnel
Lack of skilled attendance at births
Lack of transport to reach health facilities
Prohibitive cost of health care
Low/infrequent pay of health care personnel
High MMR: Contributing Factors
In 2008 MOH of Sierra Leone developed a comprehensive Reproductive and Child Health Strategic Plan ($282 million from donors), aimed at addressing the many of the barriers to maternal health care
Created a Reproductive and Child Health Unit within the Ministry of Health
Undertook (with technical assistance from UN/WHO) Nationwide Needs Assessment for Emergency Obstetric and Newborn Care Services
Worked closely with the Ministry of Health, with funding from donors including DFID, the World Bank and the African Development Bank, to provide comprehensive emergency services in seven districts
This plan will be reevaluated and measured in 2012
Public Private Partnerships in Sierra Leone Cordaid, Sierra Leone Midwives Association (SLMA), Medical Research Centre (MRC), Principal National School of Midwifery in Freetown (NSMF), Research department of Ministry of Health (RDMoH), Kenema Diocesian Health Care Office (KDHCO), University of Sierra Leone Research Institute, Principal National School of Midwifery in Freetown (NSMF), Catholic Diocese of Kenema, Church Health Association in Sierra Leone, Panguma Hospital, Royal Tropical Institute (KIT), Maastricht University Centre for International Cooperation in Academic Development (MUNDO), TNO Quality of Life, Royal Dutch Organization of Midwives (KNOV), International Confederation of Midwifes (ICM), University of Midwifery Education and Studies Maastricht (AVMU), Midwifery Academy Rotterdam (VAR), Development and Relief Corporation B.V., Malaria No More!, National Committee for International Cooperation and Sustainable Development (NCDO)
Maternal Mortality in Grenada
MMR in Grenada:
0/100,000 since 2007
Low MMR: Contributing Factors
Improved access to health facilities and maternal care
Delivery assistance from trained medical personnel
Management of complications
Uptake of post-natal care
Multi-Sector Approach to Reducing MMR Sector/Agency Approach/Action Environmental Health Department Entrusted w/ monitoring and control of public health and general health issues Caribbean Environmental Health Institute Water quality monitoring The Health Education Department Promotes health sector’s links with other sectors USAID funded health care policy Facilitated dialogue among officials of the MoH and MoF, and social institutions of the Organization of the Eastern Caribbean States WHO National Strategic Plan for Health Geared towards improving and maintaining the health of Grenadian citizens
Emphasis on Maternity Care
Provided by trained nurse midwives, maternity care emphasizes:
Third trimester coverage
Health education for women
Clear protocols for managing serious complications
Round the clock coverage
Effective referral system
Enhanced communication and record keeping
Grenada’s Health Policy Stewardship
Ministry of Health : implements and formulates healthcare policies
Community Health Services (CHS): ensures quality of primary healthcare
Environmental Health Department : monitors and controls public health and general issues
Access to quality skilled care during pregnancy, childbirth and postpartum/postnatal period
Develop health education programs on women’s health maintenance and pre-natal care
Disseminate critical information through the existing media channels
Provide comprehensive family planning services
Promote research in areas such as women’s health, cultural competency and maternal mortality
Establish maternal mortality surveillance systems to enhance collaboration
Place emphasis on preconceptional care and counseling versus dealing with labor/birth complications
"…there is no tool for development more effective than the empowermen t of women ." ~ Kofi Annan