Skilled care during pregnancy


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Skilled care during pregnancy

  1. 1. Millennium Development Goal 5 (MDG 5), improve maternal health, set the targets of reducing maternal mortality by 75% and achieving universal access to reproductive health by 2015. But, so far progress in reducing mortality in developing countries and providing family planning services has been too slow to meet the targets. -
  2. 2.  - Every pregnancy should be wanted.  - All pregnant women and their infants should be able to access and receive skilled care.  - All women should be able to reach a functioning health facility to obtain appropriate care for themselves or their newborns when complications arise during pregnancy, delivery or the postpartum period.  - Safe pregnancy, childbirth and motherhood are basic human rights.
  3. 3. Worldwide, 1000 women die every day due to complications during pregnancy and childbirth - up to 358 000 women per year. In developing countries, conditions related to pregnancy and childbirth constitute the second leading causes (after HIV/AIDS) of death among women of reproductive age.
  4. 4.  Four main killers cause around 70% of maternal deaths worldwide: Bleeding after delivery can kill even a healthy wosevere bleeding, infections, unsafe abortion, and hypertensive disorders (pre-eclampsia and eclampsia).man, if unattended, within two hours. Most of these deaths are preventable.
  5. 5.  More than 136 million women give birth a year. About 20 million of them experience pregnancy-related illness after childbirth. The list of morbidities is long and diverse, and includes fever, anemia, fistula, incontinence, infertility and depression. Women who suffer from fistula are often stigmatized and ostracized by their husbands, families and communities.
  6. 6.  Fact 4  About 16 million girls aged between 15 and 19 give birth each year, accounting for more than 10% of all births. In the developing world, about 90% of the births to adolescents occur in marriage. In many countries, the risk of maternal death is twice as high for an adolescent mother as for other pregnant women.
  7. 7.  Fact 5  The state of maternal health mirrors the gap between the rich and the poor. Only 1% of maternal deaths occur in high-income countries. A woman's lifetime risk of dying from complications in childbirth or pregnancy is an average of one in 120 in developing countries and compared to one in 44 300 in developed countries. Also, maternal mortality is higher in rural areas and among poorer and less educated communities. Of the 1000 women who die every day, 570 live in sub-Saharan Africa, 300 in South Asia and five in high-income countries.
  8. 8.  Fact 6  Most maternal deaths can be prevented through skilled care at childbirth and access to emergency obstetric care. In sub-Saharan Africa, where maternal mortality ratios are the highest, only 46% of women are attended by a trained midwife, nurse or doctor during childbirth.
  9. 9.  Fact 7  In developing countries, the percentage of women who have at least four antenatal care visits during pregnancy ranges from 34% for rural women to 67% for urban women. Women who do not receive the necessary check-ups miss the opportunity to detect problems and receive appropriate care and treatment. This also includes immunization and prevention of mother-to-child-transmission of HIV/AIDS.
  10. 10.  Fact 8  About 18 million unsafe abortions are carried out in developing countries every year, resulting in 46 000 maternal deaths. Many of these deaths could be prevented if information on family planning and contraceptives were available and put into practice.
  11. 11.  One target of the Millennium Development Goals (MDGs) is to reduce the maternal mortality ratio by three quarters between 1990 and 2015. So far, progress has been slow. Since 1990 the global maternal mortality ratio has declined by only 2.3% annually instead of the 5.5% needed to achieve MDG 5, aimed at improving maternal health.
  12. 12.  The main obstacle to progress towards better health for mothers is the lack of skilled care. This is aggravated by a global shortage of qualified health workers. By 2015 another 330 000 midwives are needed to achieve universal coverage of mothers with skilled birth attendance.
  13. 13. Evidence from the historical record suggests that the care during childbirth and reducing maternal mortality. Each can be adapted to local as well as national settings, and additional interventions (such as strengthening referral systems) may also be necessary. following are effective strategies for increasing skilled > Recognising the magnitude of the problem of maternal mortality and acknowledging that most maternal deaths are avoidable; > Making a political commitment to reducing maternal mortality, and putting in place legislation that facilitates skilled care during childbirth for all women; >
  14. 14.  Professionalising midwifery practice and ensuring that midwives are (and are seen by the publicas) competent professionals, through adoption of effective systems of supervision and accountability  Incorporating key life-saving medical skillsinto midwives’ scope of practice; and Ensuring availability of funding for skilled careat all births, along with needed supplies and equipment
  15. 15.  > Recognising the magnitude of the problem  of maternal mortality and acknowledging that most  maternal deaths are avoidable;  > Making a political commitment to reducing  maternal mortality, and putting in place legislation that  facilitates skilled care during childbirth for all women;  > Professionalising midwifery practice and  ensuring that midwives are (and are seen by the public  as) competent professionals, through adoption of  effective systems of supervision and accountability
  16. 16.  > Working with communities to create knowledge  on maternal health issues, and strengthening their  ability to make and act on decisions regarding  their health, including the use of health services;  > Ensuring effective, community-based systems of  transport, communication, and referral; and  > Establishing and maintaining a well-functioning,  well-equipped, and extensive health care system.
  17. 17. During, pregnancy a skilled attendant should be able to Monitor the health of the woman and fetus  provide preventive and curative care for common illnesses such as anaemia, sexually transmitted diseases,urinary tract infections, and malaria, as well as providetetanus toxoid immunisation; Educate clients about danger signs and offer guidance in planning for the delivery.
  18. 18.  financing universal coverage of skilled care,  it is critical that governments:  > Ensure access to care for all, especially the  very poor (e.g., through subsidies for the poor that cover  the costs of public or private care they cannot afford);  > Identify areas for cost savings based on countryspecific  figures, and use cost estimates to select the  most cost-effective interventions;
  19. 19. > Ensure regular payment of salaries in the public sector, since experience has demonstrated that health worker motivation and incentives are key to ensuring the quality and sustainability of health care services; Explore the range of options for more equitable and sustainable financing of skilled care and maternal health services, pilot-test new mechanisms (before implementing them nationally), and promote more effective implementation of current financing methods.
  20. 20.  Supportive policies, laws, and regulations that  make safe motherhood a priority;   Authorise healthprofessionals, including midwives, to carry out all   life-saving interventions in which they are proficient;and counter the range of barriers women face in  accessing care; Effective health system infrastructure,  adequate equipment and supplies and systems of  referral, communication, and transort;
  21. 21. > Professional associations that promote the velopmdeent of skilled attendants through shaping policy and protocols, establishing standards of practice and core competencies, and facilitating communication and information exchange; and > Quality education and supervision systems that offer pre-service and continuing (or in-service) education,and provide a mechanism for support
  22. 22.  Incidence of partograph use to measure the progress of labour, which can be a good indicator of the quality of care, especially during long and obstructed labours.  Client satisfaction and preferences for care, measured through qualitative approaches like client interviews and focus groups.  quantitativemeasurement instruments have been developedand used to assess client satisfaction, no consistentapproach has been developed due to the complexitiesof measurement involved.
  23. 23. > Staff skills and satisfaction, which assess providers’ clinical skills, experience, training, and communication abilities, along with work hours and salaries—all important inputs to quality care provision. Measurement of these factors is challenging: many indicators will be needed to assess the strengths and weaknesses of services
  24. 24. Two audit approaches currently being tested In “near-miss audits”,cases of severe, lifethreatening complications(rather than deaths) arereviewed in hospitals bya team of midwives,doctors, social workers,and administrators.
  25. 25.  2. Criterion-based audits involve the development  of a list of criteria for good quality care. Case notes
  26. 26. Saving Women’s Lives, Improving Newborn Health