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Prevention of Maternal Mortality_Stanton


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Prevention of Maternal Mortality_Stanton

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Prevention of Maternal Mortality_Stanton

  1. 1. USAID’s Maternal Health Vision for Action: How Can It Inform Programs?
  2. 2. Ending Preventable Maternal Mortality: USAID Maternal HealthVision for Action June 2014 Ending Preventable Maternal Mortality: USAID Maternal HealthVision for Action Evidence for Strategic Approaches January 2015
  3. 3. Ending Preventable Maternal Mortality: USAIDVision A world where no woman dies from preventable maternal causes and maternal and fetal health are improved
  4. 4. Reaching average global MMR < 70/100,00 by 2030 WHO: StrategiesToward Ending Preventable Maternal Mortality, 2015
  5. 5. 1.Improve Individual, household and community behaviors and norms —including community mobilization to hold health systems accountable 2. Improve equity of access to and use of services by the most vulnerable
  6. 6. Despite progress in coverage of maternal health services, economic disparities are significant
  7. 7. Address the knowledge/ information barrier • Health education that imparts knowledge through dialogue and problem solving • Provided through community participation or empowerment approaches in which communities are actively involved in shaping their health
  8. 8. Financial incentives can improve coverage of MH services Incentives Effects Performance based Incentives (PBI) • Most show association with ↑ quality Insurance • Most show positive correlation with SBAs and facility delivery • 6 studies show positive correlation with C/S User fee exemptions • ↑ facility delivery rates • ↑ C/S rates, in some cases Conditional cash transfers • 6 studies show positive effect on birth with SBAs • 3 studies show positive effect on birth in a hospital Vouchers • Most show ↑ SBA or facility delivery Source: JHPN on Financial Incentives for Maternal Health Services, Feb 2014
  9. 9. 3. Strengthening integration of maternal services with family planning 4. Scale up quality maternal and fetal health care 5. Prevent diagnose and treat indirect causes of maternal mortality and poor birth outcomes 6. Increase focus on averting and addressing maternal morbidity and disability 7. Advance choice and respectful maternity care – and improve working conditions for providers
  10. 10. Family planning is essential to: reduce # number of times woman is exposed to pregnancy and associated complications and the number of high risk pregnancies, including advanced age and birth order
  11. 11. Reducing maternal and fetal mortality & morbidity requires quality care for prevention, complication identification, and prompt treatment
  12. 12. Indirect causes of maternal death: - HIV/AIDS - Malaria -TB - STIs - undernutrition - obesity Anemia in pregnant women, an indirect cause of maternal mortality, and of fetal growth restriction contributing to low birth weight, is very high countries
  13. 13. Elements of disrespect and abuse… • Lack of informed consent • Lack of confidentiality • Discrimination • Physical Abuse • Undignified Care → Humiliation • Abandonment of Care • Demand for payments → Detention in Facilities Disrespect and abuse of women in childbirth has been reported in every region of the world – it is a human rights and a quality of care issue
  14. 14. 8. Strengthen and support health systems 9. Promote data for decision- making and accountability 10. Promote innovation and research for policy and programs
  15. 15. Use of private sector care for childbirth, Asia, Decade 2000-2012 Beyond the health system “pillars”, we need to understand and work within evolving contexts including: -- urbanization -- privatization -- decentralization
  16. 16. Proportion facilities and delivery rooms that are WASH safe, Tanzania Strong health system are fundamental to MM reduction. USAID will focus particularly on • Human resources • Commodities • Referral systems • Water , sanitation and hygiene (WASH) • Information systems
  17. 17. Barrier to care: Lack of data for decisions and accountability
  18. 18. Ghana substantial regional variation, with Upper East and Volta regions with highest mortality ratios Innovation New technology to report, analyze and display subnational data to propel problem solving and decisions
  19. 19. Baselin e 2013 Target 2020 ANC x 1 80% 90% ANC x 4 44% 65% SBA 51% 60% Facility delivery 34% 60% Facility delivery, rural 25% 45% Facility deliver, 2 lowest wealth quintiles 7% 20% Cesarean section, rural 3.7% 5% Cesarean section, 2 lowest wealth quintiles 0.87% 3.5% PNC within 2 days of birth, regardless of location 38.7% 55%
  20. 20. Annual Burden of Maternal and Newborn Mortality and Morbidity Beyond maternal mortality… to maternal and fetal health
  21. 21. … Mahmoud Fathalla