The major maternal health problems include unwanted pregnancy and unsafe abortion, problems related to pregnancy and childbirth, harmful traditional practices, violence against women, HIV/AIDS and STIs, cancers of the reproductive organs, and malnutrition. These problems persist due to factors operating at multiple levels, including households and communities, the health system, and public policies. Overcoming these problems requires a lifecycle approach to women's health, empowering women, improving access to reproductive healthcare and contraception, preventing violence and harmful practices, and ensuring good nutrition.

1. Major Maternal Health
Problems
Amanuel Tesfay (BSc,MPH/RH)
JU/PFHD
May, 2014
7/1/2023
1

2. Objectives
• At the end of the session you are expected to:
Describe the major maternal health problems
Describe the status of women
Identify factors affecting reproductive health
7/1/2023 2

3. Brain storming
What are the major maternal health
problems?
7/1/2023
3

4. Maternal health problems
• Women have the right to the enjoyment of the highest attainable
standard of physical and mental health.
• This is vital to their life, well-being and their ability to participate in all
areas of public and private life.
• However, they are largely suffering from problems related to sexual
health, pregnancy, contraceptive side effects etc.
7/1/2023
4

5. Maternal health problems...
• Death and illnesses from reproductive causes are highest
among poor women every where
• In Poor, illiterate and politically powerless, high rates of
reproductive illness and death are the norm.
• Highest in developing countries including Ethiopia.
• Women’s health is very important not only because of their
number but also their health is a key to the health of the
present and future generation. 7/1/2023
5

6. Maternal health problems…
• Women’s health needs differ from men because of their
biological & gender differentials in exposure to risk factors
• The life cycle of women between menarche and menopause
involves psychosocial and physiological functions of
fertility.
• So their health needs are more than men in this area
7/1/2023
6

7. cont
7/1/2023
Health problems affecting women through out their life cycle

8. Health problems affecting
women through out life cycle
• Infancy and childhood(0-9)
• Adolescence(10-19)
• Reproductive years(15-49)
• Post reproductive years(45 +)
• Life time health problems()
7/1/2023 8

9. Maternal health problems…
The major maternal health problems include
o Unintended pregnancy & Unsafe abortion
o Problems related to Pregnancy & childbirth
o HTP
o VAW
o HIV/AIDS & STIS
o Cancers of Reproductive organs
o Malnutrition and etc…
7/1/2023
9

10. (1)Unwanted pregnancy & unsafe abortion
Worldwide nearly 230 million (1 in 6) WCA lack
information on and access to a full range of contraceptive
methods.
 Contraceptive services, even where they exist, often do not meet
women’s needs.
 In developing countries more than 120 million couples
have an unmet need for safe and effective contraception
7/1/2023
10

11. Unwanted pregnancy & unsafe abortion…
• women have little control over sexual relations and
contraceptive use,
• This limits their ability to prevent unintended pregnancies
• 20% - 50% of all women report having experienced sexual
coercion, abuse, or rape, putting them at high risk for
unwanted pregnancy.
• Adolescents and unmarried women are particularly
vulnerable 7/1/2023
11

12. Unwanted pregnancy & unsafe abortion…
• Out of 182 million pregnancies occurring each year in the
developing world about 80 million or 40% are unwanted or
ill-timed.
• 46 million unwanted pregnancies end in abortion each year,
• Unsafe abortions threaten the lives of a large number of
women, representing an important public health problem.
7/1/2023
12

13. Unwanted pregnancy & unsafe abortion…
• About 20 million unsafe abortions take place each year
95% of them in the developing world.
• Complications of unsafe abortion kill at least 78,000
women every year.
• Hundreds of thousands experience short- or long-term
disabilities
7/1/2023
13

14. Estimated annual number of unsafe abortions, globally and by major regions, 2003 and 2008.
7/1/2023 14

15. Global and regional estimates of mortality due to unsafe abortion, 2008
a. Japan, Australia and New Zealand have been excluded from the regional estimates, but are included in the total for
developed countries.
b. No estimates are shown for regions where the incidence of unsafe abortion is negligible.
7/1/2023 15

16. (2)Problems related to Pregnancy & childbirth
• Every day at least 1,600 women die from the complications of
pregnancy and childbirth.
• A minimum of 585,000 women dying each year.
• Each year over 50 million women experience pregnancy-related
complications, many of which lead to long-term illness or disability.
7/1/2023
16

17. Problems related to Pregnancy & childbirth…
• A total of 99% of all maternal deaths occur in developing countries
• More than half of these deaths occur in sub-Saharan Africa and one
third in South Asia.
• Complications of pregnancy and childbirth are the leading cause of
death and disability for women in developing countries.
7/1/2023
17

18. Pregnancy & childbirth…
7/1/2023
18

19. Pregnancy & childbirth…
• The common maternal health problems during pregnancy and child
birth includes
• Eclampsia
• Anemia
• APH
• Obstructed labor, fistula, uterine prolapse
• PPH
• Sepsis, Etc…
7/1/2023
19

20. 7/1/2023 20
Source: WHO 2010. * Nearly all(99%) abortion deaths are due to unsafe
abortion. ** this category includes deaths due to obstructed labor or anemia

21. (3)Harmful traditional practices (HTP)
• Is threat to the health of mothers
• Eg. FGM, early marriage, Abduction, rape etc.
Female genital mutilation (FGM)
• FGM is practiced all over the world, more in Africa & Asia
• 100 million women and girls are estimated to have had FGM in Africa
• According to WHO report
• Every year around 2 million young girls suffer from FGM
• ETHIOPIA…………
7/1/2023
21

22. (4) Violence Against Women (VAW)
• "Any act of gender-based violence that results in, or is likely
to result in, physical, sexual or psychological harm or
suffering to women, including threats of such acts, coercion or
arbitrary deprivation of liberty, whether occurring in public or
in private life.
(Defined by The UN Declaration on the Elimination of VAW , 1993)
7/1/2023
22

23. Violence Against Women (VAW)...
• VAW is one of the most alarming health problems
• WHO estimated that:
• About one-quarter of the world’s women are subjected to
violence and abuse in their homes
• Over 50% in Thailand &
• As high as 80% in Pakistan
• Ethiopia?
7/1/2023
23
Life time prevalence physical ,sexual violence and physical or
sexual or both was 49% ,59% and 71% respectively[WHO
Multicounty study,2005]

24. VAW...
• Domestic violence is the most widespread
 Studies in 35 countries suggested that about 25-50% of all
women have been physically abused by their partner
 Adolescent girls and young women experience violence
disproportionately.
 40-58 % of sexual assaults are committed against girls aged 15
and younger.
7/1/2023
24

25. 7/1/2023 25

26. VAW...
Violence can have numerous negative consequences for
women’s sexual and RH, such as:
 Restricted access to FP information
 Unwanted pregnancies
 Unsafe abortion and its complications
 High-risk pregnancies and lack of follow up
 STIs, including HIV/AIDS
 Persistent gynecological problems
 infertility
 Psychological problems, including fear of sex and
 loss of pleasure
7/1/2023
26

27. (5) HIV/AIDS/STIs
• The HIV pandemic remains the most serious of infectious
disease challenges to public health.
• According to AIDS Epidemic updates of 2012
• Globally, 34.0 million PLHIV at the end of 2011.
• An estimated 0.8% of adults aged 15-49 years worldwide are living with
HIV,
• Sub-Saharan Africa
• 1 in every 20 adults(4.9%) living with HIV and
• accounting for 69% of the people living with HIV Worldwide.
7/1/2023
27

28. HIV/AIDS/STIs…
• Ethiopian situation
• MOH/FHAPCO, 2012
 More than 800,000 PLHIV
 1million children are AIDS orphaned
 1.5%(Male=1, Female=1.9%)[EDHS,2011]
 Urban 4.2% & rural 0.6%
7/1/2023
28

29. HIV/AIDS/STIs…
• Every day, more than 1 million people are infected with a curable STDs worldwide
• An estimated 333 million cases worldwide each year
• About 165 million among women aged 15-49 years
• Various STDs increase the risk of HIV transmission by at least 3-4 times.
• The four most common STDs:
• syphilis, gonorrhea, Chlamydia and trichomoniasis are relatively easy to cure
through antibiotic treatment.
7/1/2023
29

30. (6) Reproductive organ cancers
• Cervical cancer is an important women’s health problem in
developing countries, killing some 200,000 women each year.
• It is the third most common cancer overall and the leading cause
of death from cancer among women in developing countries.
• At least 370,000 new cases each year;
 80% in developing countries.
 Occurs worldwide, but the highest incidence rates are found in
 Central and South America, eastern Africa, South and South-East Asia
7/1/2023
30

31. 7/1/2023 31
Worldwide incidence rates of cervical cancer per 100,000 females (all ages),Age
standardized to the WHO standard population (2005)
Source: WHO(2006)

32. (7)Malnutrition
• An estimated 450 million adult women in developing countries are
stunted, a direct result of malnutrition in early life.
• Micronutrient deficiency are common problems among women,
Particularly Anemia
• According to EDHS 2011,
• 17% of mothers have any form of anemia
7/1/2023
32

33. (7)Malnutrition…
7/1/2023 33
Nutrition throughout the life cycle (SCN,UN, 2000)

34. 7/1/2023 34
Causes % of maternal
mortality
Nutritional precedent
Hemorrhage 30-35 Anemia: 59% of pregnant w
500 Million women
Induced abortion/Teenage
pregnancy
20-45 ??
Hypertension
/Eclampsia
15-25 Low calcium intake?
Infection/Sepsis 5-15 Impaired immunity: iron &
vitamin A deficiency
Exhausted: CED
Obstructed Labor 5-15 Stunted: height <150cm
500 million women
Prolonged labor --- CED: 500 million women
Wt <45kg ;BMI<18.5
Causes of maternal mortality & nutritional implications

35. Questions
• Why do you think these problems still exist?
• What contributed to their high prevalence?
7/1/2023 35

36. Factors affecting RH
7/1/2023 36

37. Factors...
• RH is a crucial part of general health and a central feature of
human development.
• In most developing-country settings, much of the loss of life and
human productivity that is due to poor RH could be prevented
with affordable and cost-effective programs.
• However, a number of factors exist affecting the existence and use
of RH services.
7/1/2023
37

38. Factors...
• The factors affect:
 The needs for RH
 The health care system &
 Health seeking behavior & service utilization
7/1/2023 38

39. Factors...
• RH affects, and is affected by, the broader context of people's lives, including
• Economic circumstances
• Education
• Employment
• Living conditions
• Family environment
• Social and gender relationships and
• The traditional and legal structures within which they live.
7/1/2023
39

40. Factors...
• Sexual and reproductive behaviors are governed by
complex biological, cultural and psychosocial factors.
• Therefore, the attainment of RH is not limited to interventions by
the health sector alone.
• The status of girls and women in society, and how they are
treated or mistreated, is a crucial determinant of their
reproductive health.
7/1/2023
40

41. Factors...
• Factors that affect RH operate at several levels:
 At Households and communities
 At the health system
 At the public polices and actions
7/1/2023
41

42. 1. Households and community
1.1.Households factors
• Health behavior :-
 avoiding or minimizing risks
 Using FP methods
 Practicing safe sex
 Dietary habits
 Utilization of health services
 Decision making process & control of resources
7/1/2023
42

43. Households factors…
• Household resources and assets
 Household income and owning
 Access to information
 Quality of housing
 Education of household members
7/1/2023
43

44. 1.2 Community factors
• Gender norms and practices
• Existence of effective community groups & social
cohesion
• Cultural and religions values
7/1/2023
44

45. 2. Health system factors
• Quality : Availability of service, supplies and skilled
professionals
• Access: Physical and financial accessibility
 Referral for complications and emergencies
 Health information campaigns
 Logistic management system for FP and other commodities
7/1/2023
45

46. Other related sectors
 Transportation,
 Communications
 Education, and
 Water and sanitation.
 Agriculture
 Etc.
7/1/2023
46

47. 3.Government policies and actions
• The manner in which revenue is raised for RH
• The amount of budget allocated for RH
• Laws and regulations
• The methods of consultation with stakeholders
• Representing women in decision making positions.
7/1/2023
47

48. • What can be Done to overcome these problems?
7/1/2023 48

49. Solutions
• Lifecycle approach to health
• Women’s right to the enjoyment of the highest
standard of health must be secured throughout the
whole life cycle
• Women empowerment & right based approach to RH
• Good health is essential to leading a productive
fulfilling life, and the right of all women to control all
aspects of their health is basic to their empowerment.
7/1/2023 49

50. Solution...
• Improve access & utilization of contraceptive methods
• Mobilizing and providing sufficient resources to meet
the growing demand for access to information, counseling,
services and follow-up on the widest possible range of
safe, effective, affordable and acceptable contraceptive
methods
• Comprehensives post abortion care & safe abortion
service
7/1/2023 50

51. Solution...
 Providing Good quality RH services
 Improving access to Essential obstetric care
 Equipping the facility with skilled human power,
equipments & necessary supplies
 Promoting good referral system
7/1/2023 51

52. Solution...
• Making STDs and HIV/AIDS prevention and control an integral
component of reproductive and sexual health programs
• Avoiding of all forms of VAW & care and support for victims of
VAW
• Avoiding all forms of harmful traditional practices.
• Good nutrition & Micronutrient supplementation for mothers
• etc
7/1/2023 52

53. 7/1/2023 53
• Central Statistical Authority (CSA) and ORC Macro, Ethiopia Demographic and Health
Survey 2011, Addis Ababa, Ethiopia, and Calverton, Maryland, USA: Central Statistical
Authority and ORC Macro, 2012.
• Comprehensive cervical cancer control : a guide to essential practice,WHO,2006
• FHI, sexual & reproductive health, In consultation with AGI, CEDPA, CMA, DSW,
CHANGE, CRLP, IBRD, IHAA, ICM, IAVI, IPPF, Partners, PC, PCI, PAI, UNAIDS,
WHO, WPF, UNFPA, and UNICEF. ©2000
• Family Care International (FCI) and The Safe Motherhood Inter Agency Group (IAG), a
comprehensive package of services for Safe Motherhood, New York, 1998. Accessed on
August 20, 2006 at: www.safemotherhood.org
• Programming for Safe Motherhood: Guidelines for Maternal and Neonatal Survival.
UNICEF, New York, 1999.
• Revised 1990 Estimates of Maternal Mortality: A New Approach by WHO and
UNICEF.Ó World Health Organization (WHO), Geneva, 1996.
• Women’s Health: Improve Our Health, Improve the World. World Health Organization
(WHO), Geneva, 1995.
• WHO, Unsafe abortion: global and regional estimates of incidence of unsafe abortion and
associated mortality in 2003. -- 5th ed.
References

54. THANK YOU
7/1/2023 54