This document discusses Ethiopia's current approach to reducing maternal and neonatal mortality. It provides context on the situation globally and in Ethiopia, including key definitions. The major causes of maternal and neonatal death are presented. Interventions shown to be effective for reducing mortality include increasing access to family planning, skilled birth attendants, and emergency obstetric and newborn care. Evidence-based practices like active management of the third stage of labor and clean delivery are emphasized.

1. Federal Democratic Republic of Ethiopia
Ministry of Health
BEmONC – LRP
ETHIOPIA
Best Practices in Maternal and Newborn Care
Current Approach to Reduction of
Maternal and Neonatal Mortality
PRESENTATION 1.2

2. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Session Objectives
 By the end of this session participants will
be able to:
 Recognize the situation of maternal and
neonatal mortality & morbidity globally and
in our country specifically.
 Describe factors affecting maternal and
perinatal mortality and morbidity.
 Review interventions to reduce maternal and
neonatal mortality
2

3. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
What Is Safe Motherhood?
3
“ A woman’s ability to have a SAFE and
healthy pregnancy and childbirth. ”

4. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Definitions
 Maternal Death = is defined as 'the death of
a woman while pregnant or within 42 days
of termination of pregnancy, irrespective of
the duration or site of pregnancy, from any
cause related to or aggravated by the
pregnancy or its management but not from
accidental or incidental causes.
 Can be Direct or Indirect Maternal Deaths
4

5. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Definitions; contd..
 Define:
 Maternal Mortality Ratio
 Perinatal Mortality
 Perinatal mortality Rate
5

6. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Definitions; contd..
 Define:
 Maternal Mortality Ratio: the number of maternal
deaths during a given time period per 100,000 live
births
 Perinatal mortality Rate ( stillbirths >28weeks and
early neonatal deaths (neonatal deaths within 7 days)
in a given population per thousand live births
6

7. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Maternal Mortality: A Global
Tragedy
 Annually, 303,000
women die of pregnancy
related complications*
 99% in developing
world
 ~ 1% in developed
countries
 Many millions more
suffer complications
e.g. obstetric fistulae,
secondary infertility
*WHO-2015 report
7

8. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Maternal Mortality trends
 Globally, the total number of maternal
deaths decreased from 543 000 in 1990 to
303 000 in 2015.
 Likewise, the global maternal mortality ratio
(MMR) declined from 400 maternal deaths
per 100 000 live births in 1990 to 216 in
2015
8

9. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
 Ask group: What are the major
causes of maternal mortality?
9

10. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
10
*Nearly all (99%) abortion deaths are due to unsafe abortion.
Other direct causes include embolism, ectopic pregnancy, anesthesia-related. Indirect
causes include: malaria, heart disease.
Source: WHO 2014
Causes of maternal deaths, global

11. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Maternal Mortality in Ethiopia
 According to EDHS 2016 only 26% of pregnancies
are attended by a skilled health provider
 Maternal mortality ratio decreased from
871/100,000 live births in 2000 to 412/100 000
live births in 2016 (DHS-2016)
 Ten countries including Ethiopia account for nearly
59% of global maternal deaths (Trends in maternal mortality:
1990 to 2015, Estimates by WHO, UNICEF, UNFPA…)
11

12. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Maternal Mortality in Ethiopia;
contd…
12

13. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Causes of maternal mortality in
Ethiopia; (Facility based study)
Women with
Complications (%)
Maternal
Deaths (%)
Total DIRECT complications/causes 90 43
• APH 4 2
• PPH/Retained placenta 7 10
• Ruptured uterus 1 2
• Obstructed/ Prolonged labor 18 4
• Postpartum sepsis 1 2
• Severe pre-eclampsia / eclampsia 6 10
• Severe complications of abortion 2 1
• Others:
Abortions with less severe complications 25 NA
Direct complications from other causes 26 12
Total INDIRECT complications/causes 10 5
• HIV/AIDS - related 7 0
• Anemia 1 2
• Other indirect causes 2 2
• Undefined cause NA 52
TOTAL 100% 100%
13
Causes of maternal mortality in Ethiopia; (Facility based study)

14. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Neonatal Health: Scope of Problem
 Newborn health and survival are closely
linked to care the mother receives before
and during pregnancy, childbirth, and the
postnatal period.
 Every year:
 4 million neonatal deaths (first month of life)
 4 million stillbirths
 Eight neonatal deaths every minute
14

15. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Two-thirds Rule
Global Infant Mortality Rates
More than 7 million infants die annually between
birth and 12 months of age
 Of those who die in the first year
 Nearly 2/3 die in the first month
 Of those who die in the first month
 2/3 die in the first week
 Of those who die in the first week
 2/3 die in the first 24 hours
15

16. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Ask group: What are major causes
of neonatal mortality?
16

17. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Causes of Newborn Death
17

18. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Ethiopia’s Neonatal Health status
 Neonatal mortality is 29 per1,000 live births (DHS
2016).
 50 percent of infant deaths in Ethiopia occur
during the first month of life.
 One in every 17 Ethiopian children dies before
reaching age one
18

19. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Child Mortality Rate trends in Ethiopia:
NMR, IMR and U5MR
19

20. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
But WHY Do These Women and
Newborns Die?
 Delay in decision to seek care
 Lack of understanding of complications
 Acceptance of maternal and newborn death
 Low status of women
 Socio-cultural barriers to seeking care
 Delay in reaching care
 Mountains, islands, rivers - poor organization
 Lack of transport
 Delay in receiving care
 Lack of triage system
 Lack of supplies, personnel
 Poorly trained personnel; poor attitudes
20
Three Delays Model

22. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Ask group: What are the key interventions to
reduce maternal and neonatal mortality?
22

23. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
What are the key interventions to
reduce maternal and neonatal mortality?
 Access to family planning
 Skilled attendants during pregnancy and
childbirth
 Access to emergency obstetric and newborn
care (EmONC),
 Effective referral system
 Fully functioning health services 24/7
23

24. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Most important intervention:
Skilled Attendant at Childbirth
A skilled health provider is:
 an accredited health professional – midwife, doctor or
nurse – who has been educated and trained to
proficiency in the skills needed to manage normal
(uncomplicated) pregnancies, childbirth and the
immediate postpartum period and in the
identification, management and referral of
complications in women and newborns
(WHO, ICM & FIGO 2004)
24
WHO 1999.

25. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
EmONC Signal Functions
Basic EmONC Comprehensive EmONC
1) Administer parenteral antibiotics Perform EmOC Signal functions 1-7,
plus:
2) Administer uterotonic drugs (e.g.
parenteral oxytocin, misoprostol)
8) Perform surgery (e.g. cesarean
delivery)
3) Administer parenteral
anticonvulsants (e.g. magnesium
sulfate)
9) Perform blood transfusion
4) Perform manual removal of placenta 10) Provision of emergency obstetric
anaesthesia
5) Perform removal of retained products
(e.g. MVA)
6) Perform assisted vaginal delivery
(e.g. vacuum extraction)
7) Perform neonatal resuscitation (e.g.
with bag and mask)
25
25

26. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Evidence based care
 For years, much of BEmONC was provided
according to “tradition” and “routine” practice
rather than according to evidence.
 To be effective, care should be evidence-based.
 We have better understanding of emergency
obstetric care (EmOC) and ‘best practices’ in
labour and delivery and
 Enhanced appreciation of the role that
community mobilization, birth preparedness,
and a continuum of care make
26

27. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Proven Interventions for Maternal
Survival
27
Source: WHO Analysis of causes of maternal deaths: A systematic review.” The Lancet, Vol 367, April 1, 2006.
Other Causes
30%
Obstructed
Labor
4% Hemorrhage
34%
Anemia
4%
Hypertensive
disorder
9%
Sepsis
16%
Unsafe
Abortion
4%
 Active
Management
of the Third Stage
of Labor
 Misoprostol
 Magnesium Sulfate
 Calcium
 Clean Delivery
 Antibiotics
 Tetanus
Toxoid
 Nutrition
Counseling
 Iron Folate
 IPTp, Malaria
Control
 Partogram
 Cesarean
Section
 Family Planning
 Postabortion
Care

28. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
What do women want?
 Clean facilities
 Women friendly care –
kindness, respect, information
 Availability of drugs and
medical equipment
 Culturally appropriate services
28

29. BEmONC – LRP: Ethiopia
Best Practices in Maternal and
Current Approach to Reduction of
Maternal and Neonatal Mortality
Summary
Skilled attendant at all childbirth
is one of the most effective
interventions to prevent maternal
and perinatal mortality and
morbidity
29